title: Repeat sentinel lymph node biopsy in patients with ipsilateral recurrent breast cancer after breast-conserving therapy and negative sentinel lymph node biopsy: a prospective study.
abstract: BACKGROUND
  Patients with ipsilateral breast tumor recurrence or new ipsilateral primary tumor after previous breast conservative surgery with negative sentinel lymph node biopsy need a new axillary staging procedure. However, the best surgical option, i.e. repeat sentinel lymph node biopsy or axillary lymph node dissection, is still debated. Purpose of the study is to assess the performance of repeat sentinel lymph node biopsy.
  
  
  METHODS
  In a multicenter study, lymph node biopsy completed by back-up axillary lymph node dissection was undertaken for ipsilateral breast tumor recurrence or new ipsilateral primary tumor. Tracer uptake was used to identify and isolate the sentinel lymph node during surgery, and it was classified after staining with hematoxylin and eosin and monoclonal anti-cytokeratin antibodies. Aside from negative predictive value, overall accuracy and false-negative rate of repeat sentinel lymph node biopsy were assessed. A multicenter, prospective study was conducted performing 30 repeat sentinel lymph node biopsy completed by back-up axillary lymph node dissection for ipsilateral breast tumor recurrence or new ipsilateral primary tumor in patients formerly treated with previous breast conservative surgery and negative sentinel lymph node biopsy. Negative predictive value, overall accuracy and false-negative rate of repeat sentinel lymph node biopsy were assessed.
  
  
  RESULTS
  Sentinel lymph nodes were mapped in 27 patients out of 30 (90%). Aberrant drainage pathways were observed in one patient (3.7%). Tracer uptake was sufficient to identify and isolate the sentinel lymph node during surgery in 23 cases (76.6%); the patients in whom lymphoscintigraphy failed or no sentinel lymph nodes could be isolated underwent axillary lymph node dissection. The negative predictive value was 95.2%, the accuracy was 95.6% and the false-negative rate was 33%.
  
  
  CONCLUSIONS
  Repeat sentinel lymph node biopsy is feasible and accurate, with a high negative predictive value. Patients with ipsilateral breast tumor recurrence or new ipsilateral primary tumor after previous breast conservative surgery and negative sentinel lymph node biopsy can be treated with repeat sentinel lymph node biopsy for the axillary staging and can be spared axillary dissection in case of absence of metastases. However, repeat sentinel lymph node biopsy may prove technically impracticable in about one quarter of cases and thus axillary lymph node dissection remains the only viable option in such instance.
authors.affiliation: Breast Surgery Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy - federicobuggi@hotmail.com.
authors.forename: Secondo
authors.initials: S
authors.lastname: Folli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Falco
authors.forename: Matteo
authors.initials: M
authors.lastname: Mingozzi
authors.forename: Federico
authors.initials: F
authors.lastname: Buggi
authors.forename: Annalisa
authors.initials: A
authors.lastname: Curcio
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Ferrari
authors.forename: Mario
authors.initials: M
authors.lastname: Taffurelli
authors.forename: Lea
authors.initials: L
authors.lastname: Regolo
authors.forename: Oriana
authors.initials: O
authors.lastname: Nanni
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D042241:Early Diagnosis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging / Q000379:methods; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012086:Reoperation; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals