Repeat sentinel node biopsy should be considered in patients with locally recurrent breast cancer

G. Vugts, A.J.G. Maaskant-Braat, A.C. Voogd, Y.E.A. van Riet, E.J.T. Luiten, E.J.T. Rutgers, H.J.T. Rutten, R.M.H. Roumen, G.A.P. Nieuwenhuijzen

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Abstract

Most patients with locally recurrent breast cancer undergo axillary lymph node dissection (ALND). However, repeat sentinel node biopsy (SNB) could provide regional nodal staging and obviate the need for standard ALND. The Sentinel Node and Recurrent Breast Cancer (SNARB) study is a Dutch nationwide registration study conducted to determine feasibility, aberrant drainage rates, and clinical consequences of repeat SNB. A total of 536 patients with locally recurrent non-metastatic breast cancer underwent lymphatic mapping and repeat SNB in 29 Dutch hospitals. A repeat sentinel node (SN) was identified in 333 of 536 patients (62.1 %) and surgically harvested in 287 patients (53.5 %). Aberrant lymph drainage was observed in 180 (54.1 %) of the 333 patients, more often after previous ALND (81.9 %) than SNB (28.4 %; P <0.001). In 230 patients (80.1 %), the retrieved SN was tumor negative; 17 SNs (5.9 %) contained a micrometastasis and 29 (10.1 %) a macrometastasis. Confirmation ALND in 31 repeat SN-negative patients revealed a macrometastasis in two patients (6.5 %). The negative predictive value (NPV) of repeat SNB was 93.6 %, and ALND was omitted in 109 of the 248 patients (44.0 %) with a negative repeat SN. In 29 of the 44 patients (63.0 %) with a positive SN, adjuvant treatment plans were altered based on the repeat SNB. Repeat SNB is a feasible procedure with a high NPV, leading to a change in management in a substantial proportion of patients. Therefore, repeat SNB should replace routine ALND and serve as the standard of care in recurrent breast cancer.

Original languageEnglish
Pages (from-to)549-556
Number of pages8
JournalBreast Cancer Research and Treatment
Volume153
Issue number3
DOIs
Publication statusPublished - Oct 2015

Keywords

  • Sentinel node biopsy
  • Recurrent breast cancer
  • Axillary lymph node dissection
  • CONSERVING THERAPY
  • RADICAL-MASTECTOMY
  • TUMOR RECURRENCE
  • FOLLOW-UP
  • CONSERVATION THERAPY
  • RANDOMIZED-TRIALS
  • PROGNOSIS
  • SURGERY
  • DISSECTION
  • CARCINOMA

Cite this

Vugts, G., Maaskant-Braat, A. J. G., Voogd, A. C., van Riet, Y. E. A., Luiten, E. J. T., Rutgers, E. J. T., Rutten, H. J. T., Roumen, R. M. H., & Nieuwenhuijzen, G. A. P. (2015). Repeat sentinel node biopsy should be considered in patients with locally recurrent breast cancer. Breast Cancer Research and Treatment, 153(3), 549-556. https://doi.org/10.1007/s10549-015-3571-4