Locoregional lymphatic recurrence following axillary dissection for breast cancer.

Abstract

19 Background: The risk of locoregional recurrence is of concern for women following breast cancer surgery. We report a single surgeon’s experience of locoregional lymphatic recurrence following axillary dissection (AD) in women with breast cancer. Methods: The aim of this study is to identify risk factors for locoregional lymphatic recurrence in women who have undergone breast surgery and AD for T1, T2 tumours. 14 women were identified over 10 years with documented recurrence in the regional lymphatic basin; ipsilateral, contralateral, supraclavicular and internal mammary lymph nodes. One patient presented with bilateral breast cancer. Patient characteristics as well as the tumour grade, ER, PR, HER2 reactivity and presence of lymphovascular invasion (LVI) were analysed. Results: Between 1996 and 2006, 756 women underwent primary surgery for breast cancer in our practice. We identified 14 women who relapsed with locoregional lymphatic recurrence and underwent further surgical management after a median follow-up of 4.5 years. 13/14 had undergone primary breast surgery at our centre, of which 73% underwent total mastectomy and AD. The median age was 48 years, 14% were nulliparous, and 50% were premenopausal. The mean tumour size was 2.48 cm and 7% had a contralateral cancer. The median axillary lymph node (LN) yield was 11.5 of which 57% (8/14) were node negative at primary surgery. In those 8 patients with negative AD, 50% recurred in the ipsilateral axillary LNs, 37.5% recurred in the ipsilateral supraclavicular LNs in the absence of axillary relapse, and 12.5% recurred in the contralateral axillary LNs in the absence of ipsilateral axillary relapse. Of the primary tumour characteristics, 13% were low grade, 43% had LVI, 57% were ER+, 64% PR+, 43% HER2+, and 14% triple negative. None of the patients had distant metastases at the time of relapse in the locoregional lymphatic basin. Conclusions: An axillary dissection did not prevent locoregional lymphatic recurrence in 14 women in our small series. On retrospective analysis, there was no dominant risk factor which could help to identify this group at high risk of relapse, although at least 50% who relapsed locoregionally were less than 50 years, premenopausal with a high tumour grade.