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Sentinel Lymph Node Biopsy for Local Recurrence of Breast Cancer After Breast-Conserving Therapy

¹ Division of Surgical Oncology, Columbia University Medical Center, 177 Fort Washington Avenue, New York, New York 10032
² Department of Nuclear Medicine, John Wayne Cancer Institute, Saint John’s Health Center, 2200 Santa Monica Boulevard, Santa Monica, California 90404
³ Lynn Sage Comprehensive Breast Center, Northwestern University Medical Center, 251 E. Huron Street, Chicago, Illinois 60611
⁴ Department of Medical Oncology, Fred Hutchinson Cancer Center, 1100 Fairview Avenue, Seattle, Washington 98109
⁵ Joyce Eisenberg-Keefer Breast Center, John Wayne Cancer Institute, Saint John’s Health Center, 2200 Santa Monica Boulevard, Santa Monica, California 90404

Correspondence: Address correspondence and reprint requests to: Armando E. Giuliano, MD; E-mail: giulianoa{at}jwci.org.

Background: Lymphatic mapping (LM) with sentinel lymph node (SLN) biopsy has revolutionized the surgical staging of primary breast cancer, but its utility and feasibility have not been established in patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and radiation.

Methods: We reviewed our breast cancer database to identify all patients who underwent preoperative lymphoscintigraphy for IBTR and whose primary tumor had been managed by BCS, SLN biopsy and/or axillary node dissection, and adjuvant breast irradiation.

Results: Preoperative lymphoscintigraphy identified migration to the regional nodal drainage basins in 11 (73%) of 15 patients, as follows: 5 ipsilateral axillary, 1 supraclavicular, 2 internal mammary, 2 interpectoral, and 3 contralateral axillary. Two patients demonstrated drainage to two nodal basins. In four patients, no drainage was observed. Intraoperative LM with radioisotope plus blue dye identified at least 1 SLN in 11 of 14 patients, and histopathologic evaluation revealed metastasis in 3 patients (2 contralateral axillary and 1 ipsilateral axillary). During preoperative lymphoscintigraphy, the radiocolloid migration time tended to be longer and the drainage pathways more variable than those associated with primary tumors.

Conclusions: LM/SLN biopsy can be successfully performed in patients with IBTR after prior BCS, axillary surgical staging, and adjuvant radiation. This approach illustrates variations in the lymphatic drainage of recurrent breast tumors and may permit the identification of regional metastasis not noted with conventional imaging techniques.

Key Words: Lymphatic mapping • Sentinel lymph node • Breast cancer • Recurrence

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