Ten-year report on axillary recurrence after negative sentinel node biopsy for breast cancer from the Swedish Multicentre Cohort Study

Boniface, Jana de; Frisell, Jan; Bergkvist, Leif; Andersson, Yvette

doi:10.1002/bjs.10411

Cited by 29 publications

(23 citation statements)

References 21 publications

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“…Despite this, axillary recurrences after a negative sentinel node biopsy are rare, which may be attributed to improved systemic therapies, unintended RT to the lower axilla by tangential fields in whole-breast irradiation, and immunological processes. In the present cohort, the 10-year axillary recurrence rate among node-negative individuals was only 1⋅6 per cent 17 . Interestingly, most reports and reviews on axillary recurrence rates after a negative sentinel node biopsy without completion axillary dissection did not elaborate on differences between BCS and mastectomy 18,19 .…”

Section: Discussioncontrasting

confidence: 66%

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

Boniface

Frisell

Bergkvist

et al. 2018

British Journal of Surgery

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BackgroundThe prognostic equivalence between mastectomy and breast‐conserving surgery (BCS) followed by radiotherapy was shown in pivotal trials conducted decades ago. Since then, detection and treatment of breast cancer have improved substantially and recent retrospective analyses point towards a survival benefit for less extensive breast surgery. Evidence for the association of such survival data with locoregional recurrence rates is largely lacking.MethodsThe Swedish Multicentre Cohort Study prospectively included clinically node‐negative patients with breast cancer who had planned sentinel node biopsy between 2000 and 2004. Axillary lymph node dissection was undertaken only in patients with sentinel node metastases. For the present investigation, adjusted survival analyses were used to compare patients who underwent BCS and postoperative radiotherapy with those who received mastectomy without radiotherapy.ResultsOf 3518 patients in the Swedish Multicentre Cohort Study, 2767 were included in the present analysis; 2338 had BCS with postoperative radiotherapy and 429 had mastectomy without radiotherapy. Median follow‐up was 156 months. BCS followed by whole‐breast irradiation was superior to mastectomy without irradiation in terms of both overall survival (79·5 versus 64·3 per cent respectively at 13 years; P < 0·001) and breast cancer‐specific survival (90·5 versus 84·0 per cent at 13 years; P < 0·001). The local recurrence rate did not differ between the two groups. The axillary recurrence‐free survival rate at 13 years was significantly lower after mastectomy without irradiation (98·3 versus 96·2 per cent; P < 0·001).ConclusionThe present data support the superiority of BCS with postoperative radiotherapy over mastectomy without radiotherapy. The axillary recurrence rate differed significantly, and could be one contributing factor in a complex explanatory model.

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Section: Discussioncontrasting

confidence: 66%

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

Boniface

Frisell

Bergkvist

et al. 2018

British Journal of Surgery

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“…Although most of the axillary recurrences occur in the first 5 years, it is proven that the axillary recurrence rate still increases after longer follow-up. 21 Therefore, the regional recurrence rate in this study could also be higher if the follow-up period would have been longer.…”

Section: Discussionmentioning

confidence: 75%

Sentinel lymph node nonvisualization after intratumoral radioisotope tracer injection in breast cancer is not associated with a higher nodal metastasis rate or worse outcomes

Hellingman

Veen

Wan

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Preoperative lymphoscintigraphy does not always visualize a sentinel lymph node (SLN). The study aim was to investigate whether persistent nonvisualization after additional single‐photon emission computed tomography (SPECT)/CT or a second radiotracer injection in breast cancer patients is associated with nodal metastases or worse outcome due to potential understaging and consequently undertreatment. Methods Altogether 2042 consecutive SLN procedures were evaluated. All patients were clinically node‐negative, underwent axillary ultrasound and fine‐needle aspiration cytology (US/FNAC) of suspicious nodes. Lymphoscintigraphy was performed at 3 to 4 hours after intratumoral injection of 99mTc‐nanocolloid. SPECT/CT or a reinjection was performed when initial lymphoscintigraphy showed nonvisualization. Results Persistent nonvisualization was seen in 170 of 2042 procedures (8.3%). The nodal metastasis rate was 16.0% vs 18.0% for procedures with nonvisualization vs SLN visualization, respectively (P = 0.593). The regional recurrence rate of tumor‐negative SLN biopsy procedures was equal between the nonvisualization (0.7%, 11 of 1535) vs visualization (0.7%, 1 of 144) group. Median follow‐up was 48 months. Distant–metastasis free interval and overall survival was not significantly different between both groups ( P = 0.164 and 0.208, respectively). Conclusions Persistent nonvisualization after lymphoscintigraphy plus SPECT/CT or radiotracer reinjection is not associated with a higher nodal metastasis rate or worse long term outcome when preoperative US/FNAC is performed.

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“…Metastasis in the axilla has traditionally been treated with axillary dissection, but the AMAROS and ACOSOG (American College of Surgeons Oncology Group) Z0011 trials proved that limited nodal disease does not require extensive surgery and that comparable locoregional control may be achieved with less morbidity. Interestingly, the 10‐year nodal recurrence rate after a negative SNB in the Swedish registry was reported to be 1·6 per cent, coinciding with the 10‐year nodal recurrence rate of 1·5 per cent after a positive SNB and adjuvant treatment from ACOSOG Z0011; this questions the need for extensive surgical procedures in the absence of axillary lymphadenopathy. On the other hand, NACT may eradicate nodal disease, but this is largely dependent on the molecular subtype; in the present analysis, the axillary conversion rate ranged from 25·0 per cent for ER‐positive tumours to 80·0 per cent for TNBC.…”

Section: Discussionmentioning

confidence: 98%

Meta-analysis of neoadjuvant therapy and its impact in facilitating breast conservation in operable breast cancer

Karakatsanis

Tasoulis

Wärnberg

et al. 2018

British Journal of Surgery

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Ten-year report on axillary recurrence after negative sentinel node biopsy for breast cancer from the Swedish Multicentre Cohort Study

Abstract: The risk of axillary recurrence remains lower than expected after a negative finding on SNB at 10-year follow-up. Axillary recurrences may occur long after primary surgery, and lead to a significant risk of breast cancer death.

Cited by 29 publications

References 21 publications

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation

Sentinel lymph node nonvisualization after intratumoral radioisotope tracer injection in breast cancer is not associated with a higher nodal metastasis rate or worse outcomes

Meta-analysis of neoadjuvant therapy and its impact in facilitating breast conservation in operable breast cancer

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