“Axillary Recurrence After a Negative Sentinel Node Biopsy”: Editorial Comment

Excerpt

I recognize Smidt et al.1 for an excellent contribution to the literature on the subject of sentinel node biopsy (SLNB) in breast cancer. SLNB is a significant advance in the management of the axilla by decreasing the incidence of lymphedema, avoiding postoperative pain, and eliminating shoulder range-of-motion complications.2‐4 I am encouraged by the data in the article by Smidt et al.1 indicating that the false-negative rate of SLNB in breast cancer is much less than earlier thought (5% vs. .25%).5 Addressing the clinical consequences of the .25% of patients who relapse is interesting speculation. Delayed axillary dissection at the time of axillary relapse should control the local disease with no effect on overall survival. This concept is controversial, and ongoing analysis is needed. Systemic failure does not occur because of axillary failure, but rather, both failures are a consequence of a more aggressive primary tumor. Systemic failure, if it occurs, in these .25% would in all probability not have been prevented if complete axillary dissection had been performed initially in place of SLNB.6 …