Abstract
Objective: Sentinel lymph node biopsy (SLNB) is a validated staging technique for breast carcinoma. Some women are exposed to have a second SLNB due to breast cancer recurrence or a second neoplasia (breast or other). Due to modified anatomy, it has been claimed that previous axillary surgery represents a contra-indication to SLNB. Our objective was to analyse the literature to assess if a second SLNB is to be recommended or not. Methods: For the present study, we performed a review of all published data during the last 10 years on patients with previous axilla surgery and second SLNB. Results: Our analysis shows that second SLNB is feasible in 70%. Extra-axillary SNs rate (31%) was higher after radical lymph node dissection (ALND) (60% - 84%) than after SLNB alone (14% - 65%). Follow-up and complementary ALND following negative and positive second SLNB shows that it is a reliable procedure. Conclusion: The review of literature confirms that SLNB is feasible after previous axillary dissection. Triple technique for SN mapping is the best examination to highlight modified lymphatic anatomy and shows definitively where SLNB must be performed. Surgery may be more demanding as patients may have more frequently extra-axillary SN only, like internal mammary nodes. ALND can be avoided when second SLNB harvests negative SNs. These conclusions should however be taken with caution because of the heterogeneity of publications regarding SLNB and surgical technique.
Highlights
Breast cancer has an incidence of 126/100,000 and is the commonest neoplasm in women [1]
Extraaxillary Sentinel lymph node biopsy (SLNB) was encountered in 114/365 patients (31%)
This figure was quite variable throughout studies as all extraaxillary sentinel lymph node (SN) were not systematically searched for in all studies despite the fact that there was a significant number of metastatic extraaxillary SNs
Summary
Breast cancer has an incidence of 126/100,000 and is the commonest neoplasm in women [1]. Melanoma has worldwide a growing incidence [3]. It is the fourth commonest neoplasm in women with an incidence of about 15/100,000. Distribution of melanoma location shows a high density on the back, shoulders and upper arms in women [4]. It is not definitively established if breast cancer incidence after melanoma is increased or not compared to incidence in the general population [5,6]. The study of Brower et al showed that breast cancer was the commonest non skin second primary cancer in melanoma patients [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
