title: Axillary recurrence after sentinel node biopsy.
abstract: BACKGROUND
  Sentinel node biopsy (SNB) has evolved as the standard of care in the surgical staging of breast cancer. This technique is accurate for surgical staging of axillary nodal disease. We hypothesized that axillary recurrence after SNB is rare and that SNB may provide regional control in patients with microscopic nodal involvement.
  
  
  METHODS
  With institutional review board approval, SNB was performed with peritumoral injection of 99mTc-labeled sulfur colloid. From 1996 to 2003, 1167 patients were entered into a prospective cancer database after surgical therapy; 916 patients consented to long-term follow-up. Fifty-two patients (5.7%) did not map successfully and were excluded, leading to a study population of 864 patients. The median follow-up was 27.4 months (range, 1-98 months).
  
  
  RESULTS
  The median number of sentinel nodes harvested was 2, and 633 (73%) patients had negative sentinel nodes. Thirty (4.7%) of those sentinel node-negative patients underwent completion axillary dissection, whereas 592 (94%) patients were followed up with observation. A total of 231 (27%) had positive sentinel nodes: 158 (68%) of these patients underwent completion axillary dissection, and 73 (32%) were managed with observation alone. Two (.32%) patients who were sentinel node negative had an axillary recurrence; one of these patients had undergone completion axillary dissection. No patient in the observed sentinel node-positive group had an axillary recurrence (odds ratio, .37; P = .725).
  
  
  CONCLUSIONS
  On the basis of a median follow-up of 27.4 months, axillary recurrence after SNB is extraordinarily rare regardless of nodal involvement, thus indicating that this technique provides an accurate measure of axillary disease and may impart regional control for patients with node-positive disease.
authors.affiliation: Feinberg School of Medicine, Northwestern University, 303 E. Chicago Avenue, Chicago, Illinois 60611, USA.
authors.forename: Jacqueline Sara
authors.initials: JS
authors.lastname: Jeruss
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Sener
authors.forename: Erika M
authors.initials: EM
authors.lastname: Brinkmann
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: Bilimoria
authors.forename: Ermilo
authors.initials: E
authors.lastname: Barrera
authors.forename: Eihab
authors.initials: E
authors.lastname: Alwawi
authors.forename: Angel
authors.initials: A
authors.lastname: Nickolov
authors.forename: G M
authors.initials: GM
authors.lastname: Schermerhorn
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy