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Second Biopsy of Axillary Sentinel Lymph Node for Reappearing Breast Cancer After Previous Sentinel Lymph Node Biopsy

¹ Division of Breast Surgery, European Institute of Oncology, Via Ripamonti, 435, 20141 Milan, Italy
² Division of Nuclear Medicine, European Institute of Oncology, Via Ripamonti, 435, 20141 Milan, Italy
³ Division of Pathology and Laboratory Medicine, European Institute of Oncology, Via Ripamonti, 435, 20141 Milan, Italy
⁴ University of Milan School of Medicine, Milan, Italy
⁵ Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti, 435, 20141 Milan, Italy

Correspondence: Address correspondence and reprint requests to: Mattia Intra, MD; E-mail: mattia.intra{at}ieo.it

Background: Sentinel lymph node biopsy (SLNB) is a safe and accurate axillary staging procedure for patients with primary operable breast cancer. An increasing proportion of these patients undergo breast-conserving surgery, and 5% to 15% will develop local relapses that necessitate reoperation. Although a previous SLNB is often considered a contraindication for a subsequent SLNB, few data support this concern.

Methods: Between January 2000 and June 2004, 79 patients who were previously treated at our institution with breast-conserving surgery and who had a negative SLNB for early breast cancer developed, during follow-up, local recurrence that was amenable to reoperation. Eighteen of these patients were offered a second SLNB because of a clinically negative axillary status an average of 26.1 months after the primary event.

Results: In all 18 patients (7 with ductal carcinoma-in-situ and 11 with invasive recurrences), preoperative lymphoscintigraphy showed an axillary sentinel lymph node, with a preoperative identification rate of 100%, and 1 or more SLNs (an average of 1.3 per patient) were surgically removed. Sentinel lymph node metastases were detected in two patients with invasive recurrence, and a complete axillary dissection followed. At a median follow up of 12.7 months, no axillary recurrences have occurred in patients who did not undergo axillary dissection.

Conclusions: Second SLNB after previous SLNB is technically feasible and likely effective in selected breast cancer patients. A larger population and longer follow-up are necessary to confirm these preliminary data.

Key Words: Breast cancer • Axillary sentinel lymph node biopsy • Reoperative biopsy • Second biopsy • Reappearing breast cancer • Recurrence

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