Staging and management of axillary lymph nodes in patients with local recurrence in the breast or chest wall after a previous negative sentinel node procedure

Derkx, F.; Maaskant-Braat, A.J.G.; van der Sangen, M.J.C.; Nieuwenhuijzen, G.A.P.; van de Poll-Franse, L.V.; Roumen, R.M.H.; Voogd, A.C.

doi:10.1016/j.ejso.2010.05.009

« Previous Next »European Journal of Surgical Oncology
Volume 36, Issue 7 , Pages 646-651, July 2010

Staging and management of axillary lymph nodes in patients with local recurrence in the breast or chest wall after a previous negative sentinel node procedure

F. Derkx
- Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Corresponding author. Tel.: +31 43 3882387.
A.J.G. Maaskant-Braat
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
M.J.C. van der Sangen
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
G.A.P. Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
L.V. van de Poll-Franse
- Eindhoven Cancer Registry, Eindhoven, The Netherlands
- Corps – Centre of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, The Netherlands
R.M.H. Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
A.C. Voogd
- Eindhoven Cancer Registry, Eindhoven, The Netherlands
- Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands

Accepted 4 May 2010.

Abstract

Objective

To evaluate axillary staging and management in patients with local recurrence (LR) after a previous negative sentinel lymph node biopsy (SNB).

Methods

Between 1999 and 2008, 130 patients with previous negative SNB developed a LR of breast or chest wall. After examination of clinical records, 70 patients met the inclusion criteria and remained available for analysis.

Results

Thirty-seven patients were treated with axillary lymph node dissection (ALND), followed by axillary radiotherapy in 9 cases. In 26 of these 37 patients no positive axillary lymph nodes were found. Nineteen patients received no treatment of the axilla at all. Of those, 9 were older than 70 years of age at diagnosis of LR. In 13 patients a second SNB was attempted, but was successful in only 5 cases. Eight patients underwent a complementary ALND. Overall, positive lymph nodes were detected in 13 of the 50 patients who underwent axillary staging, either by SNB or ALND. The median length of follow-up of the 70 patients following their diagnosis of LR was 24 months (range 2–81 months). During this follow-up period one patient developed an axillary recurrence. This was a patient who refused to undergo ALND but was given locoregional radiotherapy instead.

Conclusions

In the absence of guidelines for staging and management of the axilla at time of LR of breast or chest wall, many different strategies are being used. Considering the high rate of positive axillary lymph nodes in these patients, repeat surgical staging is appropriate.

Keywords: Breast carcinoma, Axilla, Sentinel lymph node biopsy, Lymph node dissection, Local recurrence, Staging