BS02 SENTINEL NODE BIOPSY FOR LOCALLY RECURRENT BREAST CANCER

Abstract

Purpose: Sentinel node biopsy (SNB) is standard of care for node negative, early breast cancer. There is debate as to the role of SNB in cases presenting with locally recurrent cancer or new ipsilateral cancer after breast conservation surgery or mastectomy in patients who have had a prior axillary dissection or prior SNB. The role of re‐operative SNB is evolving as is its place in staging and management.Methodology: Illustrative case histories and English language literature review.Results: High rates of ipsilateral axillary lymphatic drainage still occur in patients where only prior SNB has been performed in the axilla. When prior axillary dissection has been performed there is approximately 33–38% chance of demonstrating axillary sentinel nodes and a 28–58% chance of demonstrating non‐ipsilateral axillary / extra‐axillary drainage. The more extensive the axillary intervention the greater the chance of extra‐axillary lymphatic drainage. Common sites of non‐ipsilateral axillary lymphatic drainage include – internal mammary nodes and the contralateral axilla. Less common sites include intramammary lymph nodes both in the ipsilateral and the contralateral breast, interpectoral nodes and supraclavicular nodes. Information from the redo SNB alters management in the majority of cases. Re‐operative SNB has been reported after prior mastectomy but there is very little data available.Conclusions: Lymphatic mapping is possible in the majority of ipsilateral local recurrent and new primary breast cancer patients. Re‐operative SNB is technically feasible in the majority of cases where lymphatic drainage is demonstrated. When performed the results change management in the majority of cases.