title: Non-axillary breast cancer recurrences after sentinel node biopsy.
abstract: OBJECTIVE
  The primary lymphatic pathway of patients with breast cancer is toward the axilla, but lymph drainage is also possible towards the internal mammary chain and the supraclavicular fossa. In the current article, the development of breast cancer recurrences at these two sites after sentinel lymph node biopsy is reviewed.
  
  
  METHODS
  Since 1997, 803 patients underwent sentinel lymph node biopsy with intratumoral injection of 99mTc-nanocolloid and patent blue dye in The Netherlands Cancer Institute. All sentinel nodes as visualized on the lymphoscintigraphy images were pursued. The patients were followed prospectively for a median period of 34 months. Patients with a lymph node recurrence outside the axilla were identified and their lymphatic mapping procedures were reviewed.
  
  
  RESULTS
  Four of the 803 patients (0.5%) developed regional lymph node recurrences outside the axilla. One recurrence was located in the internal mammary chain, the other three in the supraclavicular bed. One or two of these patients also had an axillary recurrence. The sentinel node procedure had failed in two of the four patients.
  
  
  CONCLUSIONS
  The incidence of nodal recurrences outside the axilla is low. Although all extra-axillary sentinel nodes were pursued, some of these recurrences concern missed sentinel nodes that harbor metastasis. Identification of all sentinel nodes and subsequent treatment of the involved basins may reduce the risk of breast cancer recurrences in these unusual locations.
authors.affiliation: Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands. m.v.rijk@nki.nl
authors.forename: Maartje C
authors.initials: MC
authors.lastname: van Rijk
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
authors.forename: Renato A
authors.initials: RA
authors.lastname: Valdés Olmos
authors.forename: Emiel J Th
authors.initials: EJ
authors.lastname: Rutgers
authors.forename: Cornelis A
authors.initials: CA
authors.lastname: Hoefnagel
authors.forename: Bin B R
authors.initials: BB
authors.lastname: Kroon
mesh_terms: D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy