Southwestern Surgical CongressRegional recurrence in the era of sentinel lymph node biopsy
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
References (43)
- et al.
Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial
Lancet Oncol
(2010) - et al.
Presentation, management and outcome of axillary recurrence from breast cancer
Am J Surg
(2000) - et al.
Frequency, sites of relapse, and outcome of regional node failures following conservative surgery and radiation for early breast cancer
Int J Radiat Oncol
(1989) - et al.
Value of axillary dissection in addition to lumpectomy and radiotherapy in early breast cancer
Lancet
(1992) - et al.
Axillary dissection versus no axillary dissection in patients with sentinel node micrometastasis (IBCSG 23-01): a phase 3 randomised controlled trial
Lancet Oncol
(2013) - et al.
The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy
Int J Radiat Oncol Biol Phys
(2001) - et al.
Prediction of supraclavicular lymph node metastasis in breast carcinoma
Int J Radiat Oncol Biol Phys
(2002) - et al.
Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study
Lancet Oncol
(2013) - et al.
Axillary lymph node count is lower after neoadjuvant chemotherapy
Am J Surg
(2006) - et al.
Lymphatic mapping and sentinel lymphadenectomy for breast cancer
Oper Tech Gen Surg
(1994)
The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures
Ann Surg
A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer
N Engl J Med
Risk factors for locoregional recurrence among breast cancer patients: results from International Breast Cancer Study Group Trials I through VII
J Clin Oncol
Prognosis after regional lymph node recurrence in patients with stage I-II breast carcinoma treated with breast conservation therapy
Cancer
Survival following locoregional recurrence after breast conservation therapy for cancer
Ann Surg
Axillary and supraclavicular recurrences are rare after axillary lymph node dissection in breast cancer
World J Surg
Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer
J Clin Oncol
Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group
Methods
Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial
JAMA
Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial
Ann Surg
Disease recurrence in sentinel node-positive breast cancer patients forgoing axillary lymph node dissection
Ann Surg Oncol
Cited by (0)
The authors declare no conflicts of interest.