Repeat Sentinel Lymph Node Biopsy for Ipsilateral Breast Tumor Recurrence After Breast Conserving Surgery With Sentinel Lymph Node Biopsy: Pooled Analysis Using Data From a Systematic Review and Two Institutions.

Chang Ik Yoon,Sung Gwe Ahn,Soeun Park,Joon Jeong,Jung Eun Choi,Soong June Bae,Chi Hwan Cha,Dooreh Kim

doi:10.3389/fonc.2020.518568

Abstract

Introduction: Best surgical approach of axillary staging remains controversial in locally recurrent breast cancer. We evaluated the reliability of repeat sentinel lymph node biopsy (reSLNB) in patients with ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) with sentinel lymph node biopsy (SLNB) in terms of identification rate (IR) and false negative rate (FNR). To address the FNR, we identified patients who underwent sequential axillary lymph node dissection (ALND) after reSLNB.Methods: A systematic search of PubMed, EMBASE, and Cochrane Library were conducted to identify patient-level data from articles. We searched for data of patients who underwent BCS with SLNB for primary breast cancer and who underwent sequential ALND after reSLNB due to local recurrence. Patients data was also identified by the same criteria at two institutions.Results: In total, 197 peer-reviewed publications were obtained, of which 20 included patients who met the eligibility criteria. Data from 464 patients were collected. From the two institutions, 31 patients were identified. A total of 495 patients were pooled. The IR of reSLNB was 71.9% (356/495). To address the FNR of reSLNB, 171 patients who underwent ALND after reSLNB were identified. The FNR and accuracy of reSLNB were 9.4% (5/53) and 97.1% (165/170), respectively.Conclusion: Our pooled data analysis showed that the FNR of reSLNB is lower than 10%, indicating that this operation is a reliable axillary surgery in patients with IBTR after they underwent BCS.

Highlights

Best surgical approach of axillary staging remains controversial in locally recurrent breast cancer
We focused on the reliability of repeat sentinel lymph node biopsy (reSLNB) in patients who underwent breast conserving surgery (BCS) and sentinel lymph node biopsy (SLNB) without axillary lymph node dissection (ALND) as the initial surgery
To address the false-negative rate (FNR) of reSLNB, we further identified patients with ipsilateral breast tumor recurrence (IBTR) who underwent ALND after reSLNB

Summary

Introduction

Best surgical approach of axillary staging remains controversial in locally recurrent breast cancer. To address the FNR, we identified patients who underwent sequential axillary lymph node dissection (ALND) after reSLNB. Axillary lymph node dissection (ALND) has been the standard approach for axillary surgery in breast cancer. Patients treated with sentinel lymph node biopsy (SLNB) have significantly lower post-operative complication such as lymphedema, infection, seroma, and numbness compared to those with ALND [6]. Among these complication, lymphedema is one of the most common complication after ALND, and adversely affects the quality of life. SLNB is a less invasive procedure; it can replace ALND in patients with clinically node-negative breast cancer. Previous studies have reported that SLNB can accurately predict the status of the remaining axillary lymph nodes [10,11,12]

Methods

Results

Conclusion