Southwestern Surgical Congress
Regional recurrence in the era of sentinel lymph node biopsy

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Abstract

Background

The incidence of all-location regional recurrence after sentinel lymph node biopsy is not well documented. This study attempts to identify risk factors.

Methods

A prospectively maintained database was queried to identify patients with a regional recurrence of breast cancer after a first operation for invasive unilateral breast cancer. Patients with regional recurrence were compared with those alive and disease free at 5 years.

Results

Twenty-one of 1,060 patients (2%) experienced a regional recurrence. Most patients (95%) underwent sentinel lymph node biopsy as their axillary staging. Those with regional recurrences had larger tumors (P < .001), higher stage disease (P < .001), more estrogen receptor– and triple-negative breast cancers (P < .001), and more positive lymph nodes (P = .007). Mastectomy (P = .001) and receipt of neoadjuvant and/or chemotherapy (P < .001) were more common among those with regional recurrences.

Conclusions

Regional recurrence of breast cancer occurs infrequently. Risk factors include high-risk cancers, higher stage at presentation, nodal involvement, and need for therapies reflecting higher risk biology.

Section snippets

Methods

Institutional Review Board approval was obtained for retrospective evaluation of a prospective breast cancer patient database to identify patients with a regional recurrence of breast cancer after undergoing a first operation for unilateral invasive breast cancer from 1995 until 2012. All patients with ductal carcinoma in situ, known recurrent disease at presentation, and those with known metastatic disease were excluded. Patients were clinically evaluated at presentation by the treating

Patient characteristics

A total of 1,060 patients from 1995 until 2012 were identified. Twenty-one patients (2%) experienced a regional recurrence. Median follow-up time for those with a regional recurrence was 40.3 months (7.2 to 127.0 months). The distributions of the regional recurrences were axillary (12, 57%), supraclavicular (4, 19%), internal mammary (3, 14%), cervical (1, 5%), and interpectoral (1, 5%) nodes. Two patients had regional recurrences in more than 1 nodal basin. The diagnosis of regional recurrence

Comments

The overall regional recurrence rate in this cohort was low (2%). This is similar to studies of axillary dissection alone where the reported incidence of axillary recurrence is 3.6% or less.2, 3, 9, 15 In contrast, evaluation of patients with a clinically negative axilla who underwent SLN biopsy had a less than 1% rate of regional recurrence.2, 3, 6, 15, 25, 26 However, these studies mostly focus on axillary recurrences alone. Our patients' axillary recurrence rate was only 1.1%.

In the current

Conclusions

Regional recurrence of breast cancer occurs infrequently in the era of SLN biopsy. Risk factors associated with regional recurrences include larger tumor size, lymphovascular invasion, ER-negative biomarkers, and positive lymph nodes, where increased involvement of lymph nodes indicates greater risk. All these factors represent high-risk breast cancers. Surgeons should be cognizant of these factors when treating high-risk patients to ensure that meticulous axillary treatment and follow-up is

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    The authors declare no conflicts of interest.

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