title: Improving the Success Rate of Repeat Sentinel Node Biopsy in Recurrent Breast Cancer.
abstract: OBJECTIVE
  Repeat sentinel node biopsy (SNB) is an alternative to axillary lymph node dissection (ALND) for axillary staging in recurrent breast cancer. This study was conducted to determine factors associated with technical success of repeat SNB.
  
  
  METHODS
  A total of 536 patients with locally recurrent nonmetastatic breast cancer underwent lymphatic mapping (LM) and repeat SNB in 29 Dutch hospitals.
  
  
  RESULTS
  A total of 179 patients previously underwent breast-conserving surgery (BCS) with SNB, 262 patients BCS with ALND and 61 patients mastectomy, 35 with SNB and 26 with ALND. Another 34 patients underwent breast surgery without axillary interventions. A repeat sentinel node (SN) was identified in 333 patients (62.1 %) and was successfully removed in 235 (53.5 %). The overall repeat SN identification rate was 62.1 %, varying from 35 to 100 % in the participating hospitals. Previous radiotherapy of the breast [odds ratio (OR) 0.16; 95 % confidence interval (CI) 0.03-0.84], subareolar tracer injection (OR 0.34; 95 % CI 0.16-0.73), and a 2-day LM protocol (OR 0.57; 95 % CI 0.33-0.97) after previous BCS were independently associated with failure of SN identification. Injection of a larger amount of tracer (>180 MBq) led to a higher identification rate (OR 4.40; 95 % CI 1.45-13.32).
  
  
  CONCLUSIONS
  Repeat SNB is a technically feasible procedure for axillary staging in recurrent breast cancer patients. Previous radiotherapy appears to be associated with failure of SN identification. Injection with a larger amount of tracer (>180 MBq) leads to a higher identification rate; subareolar injection and a 2-day LM protocol after previous BCS appear to be less adequate.
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. guusje.vugts@catharinaziekenhuis.nl.
authors.forename: G
authors.initials: G
authors.lastname: Vugts
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: A J G
authors.initials: AJ
authors.lastname: Maaskant-Braat
authors.affiliation: Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.|Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.|GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Y E A
authors.initials: YE
authors.lastname: van Riet
authors.affiliation: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.|Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands.
authors.forename: R M H
authors.initials: RM
authors.lastname: Roumen
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: E J T
authors.initials: EJ
authors.lastname: Luiten
authors.affiliation: Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: E J Th
authors.initials: EJ
authors.lastname: Rutgers
authors.affiliation: Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Wyndaele
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: G A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008408:Mastectomy; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate