Reoperative Sentinel Lymph Node Biopsy: Adding Nuance to the Management of Locally Recurrent Breast Cancer

Excerpt

Since the pioneering reports of Krag et al.1 and Giuliano et al.2 >10 years ago, sentinel lymph node (SLN) biopsy has emerged as a new method for axillary lymph node staging in breast cancer and has become standard care at many institutions in the United States and worldwide. A current meta-analysis3 of 69 published studies of SLN biopsy validated by a backup axillary lymph node dissection (ALND) confirms an overall success rate of 96%, with the SLN falsely negative in 7.3% of node-positive cases. Observational studies have asked and answered many questions regarding definition, case selection, technique (nuclear medical, surgical, and pathologic), learning curve, and, most importantly, safety. The morbidity of SLN biopsy, although not zero, is less than that of ALND,4,5 and axillary local recurrence (LR) after a negative SLN biopsy is both comparable to that of ALND and vanishingly rare, occurring in 0.12% of our own patients at 30 months’ follow-up.6 It appears that few false-negative SLN procedures, if any, ever result in axillary LR. Three randomized trials5,7,8 of identical design address the survival equivalence of SLN biopsy and ALND and are almost certain to demonstrate no difference. Finally, two trials,7,9 through a physician- and patient-blinded design, promise an answer to the still-controversial subject of prognostic significance in immunohistochemically detected SLN micrometastases. …