title: Repeat sentinel node biopsy should be considered in patients with locally recurrent breast cancer.
abstract: Most patients with locally recurrent breast cancer undergo axillary lymph node dissection (ALND). However, repeat sentinel node biopsy (SNB) could provide regional nodal staging and obviate the need for standard ALND. The Sentinel Node and Recurrent Breast Cancer (SNARB) study is a Dutch nationwide registration study conducted to determine feasibility, aberrant drainage rates, and clinical consequences of repeat SNB. A total of 536 patients with locally recurrent non-metastatic breast cancer underwent lymphatic mapping and repeat SNB in 29 Dutch hospitals. A repeat sentinel node (SN) was identified in 333 of 536 patients (62.1 %) and surgically harvested in 287 patients (53.5 %). Aberrant lymph drainage was observed in 180 (54.1 %) of the 333 patients, more often after previous ALND (81.9 %) than SNB (28.4 %; P < 0.001). In 230 patients (80.1 %), the retrieved SN was tumor negative; 17 SNs (5.9 %) contained a micrometastasis and 29 (10.1 %) a macrometastasis. Confirmation ALND in 31 repeat SN-negative patients revealed a macrometastasis in two patients (6.5 %). The negative predictive value (NPV) of repeat SNB was 93.6 %, and ALND was omitted in 109 of the 248 patients (44.0 %) with a negative repeat SN. In 29 of the 44 patients (63.0 %) with a positive SN, adjuvant treatment plans were altered based on the repeat SNB. Repeat SNB is a feasible procedure with a high NPV, leading to a change in management in a substantial proportion of patients. Therefore, repeat SNB should replace routine ALND and serve as the standard of care in recurrent breast cancer.
authors.affiliation: Department of Surgery, Catharina Hospital, Postbus 1350, 5602 ZA, Eindhoven, The Netherlands. guusje.vugts@catharinaziekenhuis.nl.
authors.forename: G
authors.initials: G
authors.lastname: Vugts
authors.affiliation: Department of Surgery, Catharina Hospital, Postbus 1350, 5602 ZA, 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 (IKNL), Utrecht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: Department of Surgery, Catharina Hospital, Postbus 1350, 5602 ZA, Eindhoven, The Netherlands.
authors.forename: Y E A
authors.initials: YE
authors.lastname: van Riet
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, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: E J Th
authors.initials: EJ
authors.lastname: Rutgers
authors.affiliation: Department of Surgery, Catharina Hospital, Postbus 1350, 5602 ZA, Eindhoven, The Netherlands.|Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands.|GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: R M H
authors.initials: RM
authors.lastname: Roumen
authors.affiliation: Department of Surgery, Catharina Hospital, Postbus 1350, 5602 ZA, 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 / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy
keywords: Axillary lymph node dissection; Recurrent breast cancer; Sentinel node biopsy