title: Second Axillary Sentinel Lymph Node Biopsy for Breast Tumor Recurrence: Experience of the European Institute of Oncology.
abstract: OBJECTIVE
  This retrospective study aimed to determine the feasibility, accuracy, and recurrence rates of lymphoscintigraphy and the new sentinel lymph node biopsy (SLNB) for patients with ipsilateral breast tumor recurrences who were treated previously with conservative surgery and had negative SLNB results.
  
  
  METHODS
  The study was conducted at the European Institute of Oncology in Milan and included 212 patients with the diagnosis of operable local breast cancer recurrence. They had been treated previously with conservative surgery and showed negative SLNB results. They subsequently underwent additional breast surgery and a second SLNB between May 2001 and December 2011.
  
  
  RESULTS
  Preoperative lymphoscintigraphy demonstrated at least one new axillary sentinel lymph node (SLN) in 207 patients (97.7 %), whereas no drainage was observed in five patients (2.3 %). One or more SLNs were surgically removed from 196 of the 207 patients. Isolation of SLNs from the remaining 11 patients could not be accomplished. The success rate for the SLNB was 92.5 %. Extra-axillary drainage pathways were visualized in 17 patients (8 %). The annual axillary recurrence rate after a median follow-up period of 48 months was 0.8 %, and the cumulative incidence of axillary recurrence at 5 years was 3.9 %.
  
  
  CONCLUSIONS
  A second SLNB should be considered for patients with operable local breast tumor recurrence who underwent conservative surgery and had negative SLNB results. The procedure is technically feasible and accurate for selected patients.
authors.affiliation: Division of Breast Surgery, European Institute of Oncology, Milan, Italy, mattia.intra@ieo.it.
authors.forename: M
authors.initials: M
authors.lastname: Intra
authors.forename: G
authors.initials: G
authors.lastname: Viale
authors.forename: J
authors.initials: J
authors.lastname: Vila
authors.forename: C M
authors.initials: CM
authors.lastname: Grana
authors.forename: A
authors.initials: A
authors.lastname: Toesca
authors.forename: O
authors.initials: O
authors.lastname: Gentilini
authors.forename: V
authors.initials: V
authors.lastname: Galimberti
authors.forename: P
authors.initials: P
authors.lastname: Veronesi
authors.forename: A
authors.initials: A
authors.lastname: Luini
authors.forename: N
authors.initials: N
authors.lastname: Rotmensz
authors.forename: V
authors.initials: V
authors.lastname: Bagnardi
authors.forename: D
authors.initials: D
authors.lastname: Mattar
authors.forename: M
authors.initials: M
authors.lastname: Colleoni
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005060:Europe / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008408:Mastectomy / Q000009:adverse effects*; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate