Axillary Recurrence after Sentinel Node Biopsy

Abstract

Summary: Background: Sentinel lymph node biopsy seems to be a promising new method for determining axillary status in breast cancer. The method helps to reduce morbidity, and an increased number of micrometastases are detected in the sentinel nodes by which patients with a less favourable outcome are identified. However, no long‐term follow‐up data is available. Methods: Data from 1567 breast cancer patients treated at nine institutions in Austria were collected in a centrally reviewed database. Included in this study were 383 patients with a negative sentinel node biopsy who were treated without axillary dissection. The median follow‐up was 19.5 months. Results: Sentinel node biopsy was performed using blue dye (21.2 %), radiocolloid (24 %) or the combination of both methods (54.8 %).Two axillary recurrences were observed. Both patients developed distant disease synchronously or metachronously. Primary tumours of both patients showed high nuclear grading and negative hormone receptor status. Tumour size at primary diagnosis was 12 mm and 22 mm, respectively. Conclusions: The current results of sentinel node biopsy seem to confirm the accuracy of the method. There are only sporadic reports in the literature on axillary recurrence after sentinel node biopsy. The risk of treatment failure after sentinel node biopsy can only be determined after the completion of prospective randomized trials. Therefore, sentinel node biopsy should be performed within therapeutic concepts with quality control.

Factors Affecting Identification Rate and Positivity of the Sentinel Node in Breast Cancer in 1567 Patients, Using Blue Dye and 99 mTc-Labelled Colloid, Based on a Multicentre Database Project in Austria

“…The consequences of a false negative SN may be substantial, although unknown to date. It still remains unclear whether a false negative SN necessarily leads to a decrease in survival (24), but it should absolutely discourage the uncontrolled experimentation brought on by public media interest and patient demand. Quality control for each surgeon and institution is the key issue in sentinel node biopsy, whether within a controlled clinical study or, as we have presented, within a prospective multicentre database concept.…”

The Importance of Sentinel Node Biopsy in Breast Surgery

“…They showed that only a few patients (6.7 %) developed local recurrence if axillary dissection was omitted because of clinically clear axillary nodes, and that their life expectancy was unaffected. Meanwhile, the substantial reduction in postoperative morbidity, both immediate and late, by SNB only (28, 34, 35, 64, 65) and the extremely low local recurrence rate (58) were confirmed in several studies. The local recurrence rate should not exceed the 1 % level known from axillary dissection.…”

Axillary Recurrence Rate in Patients with Breast Cancer and Negative Sentinel Lymph Node Biopsy

“…One case (0.3%) presented with distant metastases without local recurrence and axillary recurrence developed in 2 cases (0.5%). In one case, 2 lymph nodes and in another case, 1 lymph node each sized 22 mm in diameter were removed, and the latter patient died 2 months after diagnosis (40).…”