Lymphatic mapping after previous breast surgery

Maaskant‐Braat, A. J. G.; Bruijn, S.Z. de; Woensdregt, Karlijn; Pijpers, H. J.; Voogd, Adri C.; Nieuwenhuijzen, Grard A. P.

doi:10.1016/j.breast.2011.10.007

Cited by 24 publications

(21 citation statements)

References 38 publications

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“…After radiotherapy and surgery of the breast and/or axilla, drainage in rSLNB outside the ipsilateral axilla is described in 18–70% of patients. 3 , 23 , 31 In this cohort of patients, 48.3% of the rSLNBs were located in an aberrant lymph node station. With the visualization of aberrant lymph drainage in IBTR patients, it is assumed that rSLNB is a more accurate staging method than ipsilateral ALND.…”

Section: Discussionmentioning

confidence: 74%

Risk of Regional Recurrence After Negative Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence

et al. 2018

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BackgroundRepeat sentinel lymph node biopsy (rSLNB) has increasingly been used in patients with ipsilateral breast tumor recurrence (IBTR). The safety in terms of regional disease control after this procedure remains unclear. This study evaluates occurrence of regional recurrence as first event in patients with IBTR and negative rSLNB, treated without additional lymph node dissection.Patients and MethodsData were obtained from the Sentinel Node and Recurrent Breast Cancer (SNARB) study. In 201 patients, tumor-negative rSLNB was obtained without performing additional lymph node dissections.ResultsWith median follow-up of 4.7 (range 0.9–12.7) years, regional recurrence occurred after median time of 3.0 (range 0.4–6.7) years in 4.5% (N = 9) of patients as first event after IBTR and rSLNB. In four of these nine patients, the site of recurrence was in concordance with the anatomical location of rSLNB. Two of the nine recurrences were reported in the ipsilateral axilla, resulting in an ipsilateral axillary regional recurrence rate of 1.0%. In the other seven patients, regional recurrence occurred in aberrant basins. Univariable analysis showed that triple-negative IBTR and lower amount of radioactive-labeled tracer (99mtechnetium) used during rSLNB were associated with developing regional recurrence as first event after negative rSLNB (P < 0.05).ConclusionsThe risk of developing regional recurrence after negative rSLNB is low. The low relapse rate supports the safety of rSLNB as primary nodal staging tool in IBTR. The time has come for clinical guidelines to adopt rSLNB as axillary staging tool in patients with IBTR.Electronic supplementary materialThe online version of this article (10.1245/s10434-018-6384-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 74%

Risk of Regional Recurrence After Negative Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence

et al. 2018

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“…According to an actual meta-analysis of the literature (by Maaskant-Braat et al .) [7], which includes all studies on repeat sentinel node biopsy in patients with locally recurrent breast cancer, aberrant drainage pathways were visualized (43.2%).…”

Section: Resultsmentioning

confidence: 99%

“…In the systematic review and meta-analysis of the literature by Maaskant-Braat et al ., sentinel node identification was successful in 452 of 692 patients (65.3%). The identification rate was significantly lower in patients who had undergone a previous ALND (52.2%) ( P < 0.0001) compared to patients who had undergone a previous SLNB (81%) [7]. …”

Section: Resultsmentioning

confidence: 99%

Management of sentinel node re-mapping in patients who have second or recurrent breast cancer and had previous axillary procedures

et al. 2014

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BackgroundIn patients with recurrent or second primary ipsilateral breast cancer, axillary staging is the key factor in locoregional control and a strong prognostic characteristic. The efficient evaluation of lymphatic drainage of re-sentinel lymph node biopsies (re-SLNBs) has remained a challenge in the management of ipsilateral primary or recurrent breast cancer patients who are clinically lymph node negative. This study explores whether a SLNB for patients with primary or recurrent breast cancer is possible after previous axillary surgery. It evaluates potential reasons for mapping failure that might be associated with patients in this group.MethodsBetween March 2006 and November 2013, 458 patients were subjected to a breast SLNB. A lymphoscintigraphy procedure was performed on 330 patients for sentinel lymph node (SLN) mapping on the day of surgery. Seven patients with either a second primary cancer in the same breast or recurrent breast cancer were described. Two of these seven patients had axillary lymph node dissection (ALND) during previous treatments and five had SLNB. A dual mapping method was used for all patients. Preoperative lymphoscintigraphy was performed four hours before surgery.ResultsSLNs were successfully remapped in six of seven (85.7%) patients, of whom five (71.43%) had previously undergone SLNB and two (28.57%) previous ALND. Localizations of SLNs were ipsilateral axillary in three patients, ipsilateral internal mammary in one patient, and contralateral axillary in two patients. An altered distribution of lymph nodes was discovered in both patients with previous ALND. In one of the two patients, metastases were found in an aberrant lymph drainage basin at the location of a non-ipsilateral axillary node (contralateral axillary SLN). The second previously ALND patient had an internal mammary SLN. In one patient, mapping was unsuccessful and the SLN was not identified.ConclusionsAltered lymphatic drainage incidence increases following breast-conserving surgery for an initial breast cancer, and the location of SLNs becomes unpredictable at the time of a second primary or recurrent ipsilateral breast cancer. This leads to the necessity of using a radionuclide (lymphoscintigraphy) for a successful re-mapping procedure. A re-SLNB is precise and beneficial even though there are few patients. A lymphoscintigraphy can identify SLNs at their new unpredicted location.

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“…The status of axillary lymph nodes determines whether the treatment should be more or less invasive, indicating either axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB),3–5 respectively. Surgical injuries resulting from ALND cause obstruction of the primary route of lymphatic drainage of the arm,5,6 leading to postoperative complications, such as hemorrhage, infection, seroma, axillary web syndrome, chronic pain, paraesthesia caused by intercostobrachial nerve damage, reduced range of motion and muscle weakness on the shoulder ipsilateral to the surgery, and, especially, lymphedema 7,8. More conservative intraoperative techniques to approach the axillary chain, such as SLNB have been used in an attempt to prevent lymphedema.…”

Section: Introductionmentioning

confidence: 99%

Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer

Sarri¹,

Dias²,

Laurienzo³

et al. 2017

OTT

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PurposeCompare the lymphatic flow in the arm after breast cancer surgery and axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB) using lymphos-cintigraphy (LS).Patients and methodsA cross-sectional study with 39 women >18 years who underwent surgical treatment for unilateral breast cancer and manipulation of the axillary lymph node chain through either ALND or SLNB, with subsequent comparison of the lymphatic flow of the arm by LS. The variables analyzed were the area reached by the lymphatic flow in the upper limb and the sites and number of lymph nodes identified in the ALND or SLNB groups visualized in the three phases of LS acquisition (immediate dynamic and static images, delayed scan images). For all analyses, the level of significance was set at 5%.ResultsThere was a significant difference between the ALND and SLNB groups, with predominant visualization of lymphatic flow and/or lymph nodes in the arm and axilla (P=0.01) and extra-axillary lymph nodes (P<0.01) in the ALND group. There was no significant difference in the total number of lymph nodes identified between the two groups. However, there was a significant difference in the distribution of lymph nodes in these groups. The cubital lymph node was more often visualized in the immediate dynamic images in the ALND group (P=0.004), while the axillary lymph nodes were more often identified in the delayed scan images of the SLNB group (P<0.01). The deltopectoral lymph node was only identified in the ALND group, but with no significant difference.ConclusionThe lymphatic flow from the axilla was redirected to alternative extra-axillary routes in the ALND group.

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Lymphatic mapping after previous breast surgery

Abstract: Lymphatic mapping seems feasible after previous BCT with axillary treatment, in spite of a relatively low identification rate. Aberrant drainage tends to be more frequent after previous treatment with ALND.

Cited by 24 publications

References 38 publications

Risk of Regional Recurrence After Negative Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence

Risk of Regional Recurrence After Negative Repeat Sentinel Lymph Node Biopsy in Patients with Ipsilateral Breast Tumor Recurrence

Management of sentinel node re-mapping in patients who have second or recurrent breast cancer and had previous axillary procedures

Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer

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