Lymphatic Mapping and Sentinel Lymph Node Biopsy for Locally Recurrent Breast Cancer: New Clues to Understanding the Biology of Chest Wall Relapse

Excerpt

Local recurrence is a well-documented risk that threatens all patients after primary surgery for breast cancer. It will complicate the outcome of 10% to 15% of cases managed by lumpectomy and breast radiation, and 5% to 10% of mastectomy cases.1 The magnitude of this risk has been evident to surgeons for several decades, and patients are routinely warned about this at the time of their initial counseling regarding the choice of mastectomy versus breast preservation. Nonetheless, when local recurrence occurs, it is an extremely difficult situation for patient and surgeon alike. The patient is undeniably traumatized the most by this event, having to face the distress and pain of cancer treatment yet again, as well as the heightened fear of cancer mortality. Caring for a patient with a local recurrence imposes a different set of stressors on the surgeon. As physicians, we hate to see our patients experience suffering, and as surgeons, we are dismayed by the definitive, tangible evidence that our technical skill in treating breast cancer is clearly inadequate for some cases. Furthermore, we are in the challenging situation of trying to define the extent to which the recurrence was primarily a consequence of inherent tumor biology, in which case aggressive systemic therapy to protect the patient from distant organ metastases is essential. Alternatively, the local recurrence may be an indicator of hyperproliferative residual breast tissue for which more extensive local therapy (surgery and radiation if possible) may be curative. …