title: Axillary recurrence after a negative sentinel node biopsy for breast cancer: incidence and clinical significance.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) carries the inherent risk of approximately 5% false-negative sampling. Undetected tumor-positive nodes of clinical importance are those that lead to axillary recurrence. This survey aims at clarifying the extent of this problem in current practice and literature.
  
  
  METHODS
  In a regional teaching hospital, 696 consecutive breast cancer patients underwent SLNB between January 1998 and July 2003, and data were entered in a prospective database. PubMed and the Cochrane library were searched for a systematic review of the literature. Thirteen studies dealt with the follow-up of a cohort of sentinel lymph node (SLN)-negative patients or presented a case report.
  
  
  RESULTS
  The SLN identification rate was 97.1%. The SLN was tumor free in 439 (65%) of the 676 patients. After a median follow-up of 26 months, axillary recurrence was detected in 2 of 439 patients 4 and 27 months after the SLNB. The incidence of clinically apparent false-negative SLNB is .46%. The systematic review resulted in 3184 SLNB-negative patients with a median follow-up of 25 months. Axillary recurrence occurred in eight patients after a median of 21 months. The axillary recurrence rate in the literature is .25%. One third of these patients present with synchronous systemic metastases.
  
  
  CONCLUSIONS
  Axillary recurrences after a negative SLNB occur, but at a much lower rate than would be expected on the basis of historical figures and the false-negative SLN findings. The natural history of axillary relapse after negative SLNB resembles the locoregional recurrence of breast cancer.
authors.affiliation: Department of Surgical Oncology, C22, Canisius Wilhelmina Hospital, PO Box 9015, 6500, GS Nijmegen, The Netherlands. marjoleinsmidt@yahoo.com
authors.forename: Marjolein L
authors.initials: ML
authors.lastname: Smidt
authors.forename: Caroline M M
authors.initials: CM
authors.lastname: Janssen
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Kuster
authors.forename: Erik D M
authors.initials: ED
authors.lastname: Bruggink
authors.forename: Luc J A
authors.initials: LJ
authors.lastname: Strobbe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D015331:Cohort Studies; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000592:standards*