title: Axillary recurrence rate after negative sentinel node biopsy in breast cancer: three-year follow-up of the Swedish Multicenter Cohort Study.
abstract: BACKGROUND
  Sentinel lymph node biopsy is an established staging method in early breast cancer. After a negative biopsy, most institutions will not perform a completion axillary dissection. The present study reports the current axillary recurrence (AR) rate, overall and disease-free survival in the Swedish Multicenter Cohort Study.
  
  
  METHODS
  From 3534 patients with primary breast cancer < or =3 cm prospectively enrolled in the Swedish multicenter cohort study, 2246 with a negative sentinel node biopsy and no further axillary surgery were selected. Follow-up consisted of annual clinical examination and mammography. Twenty-six hospitals and 131 surgeons contributed to patient accrual.
  
  
  RESULTS
  After a median follow-up time of 37 months (0-75), the axilla was the sole initial site of recurrence in 13 patients (13 of 2246, 0.6%). In another 7 patients, axillary relapse occurred after or concurrently with a local recurrence in the breast, and in a further 7 cases, it coincided with distant or extra-axillary lymphatic metastases. Thus, a total of 27 ARs were identified (27 of 2246, 1.2%). The overall 5-year survival was 91.6% and disease-free survival 92.1%.
  
  
  CONCLUSIONS
  This is the first report from a national multicenter study that covers, not only highly specialized institutions but also small community hospitals with just a few procedures per year. Despite this heterogeneous background, the results lie well within the range of AR rates published internationally (0%-3.6%). The sentinel node biopsy procedure seems to be safe in a multicenter setting. Nevertheless, long-term follow-up data should be awaited before firm conclusions are drawn.
authors.affiliation: Department of Surgery and Center for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Bergkvist
authors.forename: Jana
authors.initials: J
authors.lastname: de Boniface
authors.forename: Per-Ebbe
authors.initials: PE
authors.lastname: Jönsson
authors.forename: Christian
authors.initials: C
authors.lastname: Ingvar
authors.forename: Göran
authors.initials: G
authors.lastname: Liljegren
authors.forename: Jan
authors.initials: J
authors.lastname: Frisell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology