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10.1245/ASO.2005.08.906
Annals of Surgical Oncology 12:9 (2005)
© 2005 Society of Surgical Oncology
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Editorial

"Axillary Recurrence After a Negative Sentinel Node Biopsy": Editorial Comment

Philip Z. Israel, MD

The Breast Center, 702 Canton Road, Marietta, Georgia 30060

Correspondence: Address correspondence and reprint requests to: Philip Z. Israel, MD; E-mail: pzisrael{at}aol.com

I recognize Smidt et al.1 for an excellent contribution to the literature on the subject of sentinel node biopsy (SLNB) in breast cancer. SLNB is a significant advance in the management of the axilla by decreasing the incidence of lymphedema, avoiding postoperative pain, and eliminating shoulder range-of-motion complications.2–4 I am encouraged by the data in the article by Smidt et al.1 indicating that the false-negative rate of SLNB in breast cancer is much less than earlier thought (5% vs. .25%).5 Addressing the clinical consequences of the .25% of patients who relapse is interesting speculation. Delayed axillary dissection at the time of axillary relapse should control the local disease with no effect on overall survival. This concept is controversial, and ongoing analysis is needed. Systemic failure does not occur because of axillary failure, but rather, both failures are a consequence of a more aggressive primary tumor. Systemic failure, if it occurs, in these .25% would in all probability not have been prevented if complete axillary dissection had been performed initially in place of SLNB.6

Received for publication July 28, 2004. Accepted for publication August 23, 2004.

REFERENCES

  1. Smidt MC, Janssen CMM, Kuster DM, Bruggink EDM, Strobbe LJA. Axillary recurrence after a negative sentinel node biopsy for breast cancer: incidence and clinical significance. Ann Surg Oncol 2005;12:(in press).
  2. Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997;15:2345–50.[Abstract/Free Full Text]
  3. Giuliano AE, Dale PS, Turner RR, et al. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 1995;222:394–9.[Medline]
  4. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 1998;339:941–6.[Abstract/Free Full Text]
  5. Estourgie SH, Nieweg OE, Rutgers EJ, Kroon BB. What is a false negative result for sentinel node procedures in breast cancer? J Surg Oncol 2003;82:141–2.[Medline]
  6. Fisher B, Redman C, Fisher ER, et al. Ten year results of a randomized clinical trial comparing radical mastectomy with or without radiation. N Engl J Med 1985;312:674–81.[Abstract]




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