54de la recherche du ganglion sentinelle en cas de rechute locale

http://documents.irevues.inist.fr/bitstream/handle/2042/53904/SFSPM_2013_387.pdf;sequence=1

Breast conservation therapy (BCT) with sentinel lymph node (SLN) biopsy is a well-established standard of care for primary operable breast cancer; 5–10% of BCT patients will develop local recurrence (LR). The question then arises: How best to manage the axilla in the setting of LR after previous BCT and SLN biopsy or axillary dissection (ALND)? Between 9/96 and 12/04, 117 reoperative SLN were performed for LR after BCT and either SLN biopsy or ALND more than 6 months previously. Because of wide variation in the number of nodes removed at the initial procedure, validation by backup ALND was not feasible in all cases. Reoperative SLN was successful in 64/117 (55%) patients. SLNs were identified by isotope and dye in 28/64 (44%); isotope only in 29/64 (45%); dye only in 4/64 (6%); 3/64 (5%) unknown. Positive reoperative SLN were found in 10/64 (16%) successful cases. Among 54/64 (84%) patients with negative reoperative SLNs, 23 (43%) had additional non-SLN removed concurrently: these were negative in 21/23 cases (91%). In 2/23 (9%), reoperative SLN were falsely negative: one with a positive intramammary node, and the other with a positive non-SLN palpated at surgery. Success of reoperative SLN was inversely related to number of nodes removed previously, and was more likely to be successful after a previous SLN biopsy than a previous ALND (74% vs. 38%, P = 0.0002). Non-axillary drainage was identified by lymphoscintigraphy significantly more often in reoperative SLN than in primary SLN biopsy (30% vs. 6%, P < 0.0001). There were no local or axillary recurrences at a mean follow up of 2.2 years; 6 patients developed systemic recurrence. Reoperative SLN biopsy is feasible in the setting of LR after previous BCT/axillary surgery and deserves further study in this increasingly common clinical scenario. The added benefit of lymphoscintigraphy in identifying sites of non-axillary drainage may be greater in the setting of reoperative SLN than for the initial SLN procedure.

Reoperative sentinel lymph node biopsy: a new frontier in the management of ipsilateral breast tumor recurrence.

Background:

Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in patients with primary operable breast cancer and uninvolved axillary nodes. These patients increasingly have breast-conserving surgery (BCS), and 5 to 10 per cent develop ipsilateral breast tumour recurrence during follow-up. If axillary nodes remain clinically uninvolved after a previous negative SLNB the question remains whether second SLNB is a suitable option.



Methods:

Between January 2000 and October 2006, 202 patients who had previously had BCS and a negative SLNB developed an ipsilateral breast tumour recurrence. Of these, 65 women with clinically negative axillary nodes were offered a second SLNB; 57 had received adjuvant radiotherapy after BCS.



Results:

In 63 women, preoperative lymphoscintigraphy showed an axillary sentinel node (identification rate 97 per cent). In five, this was associated with extra-axillary migration. Sentinel node metastases were detected in seven women; in two this was the only metastasis. At a median follow-up of 45·9 months, no axillary recurrence had occurred in the women who had not had axillary dissection.



Conclusion:

Second SLNB after previous BCS and negative SLNB plus adjuvant radiotherapy may be offered to selected women with ipsilateral breast tumour recurrence. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Second axillary sentinel node biopsy for ipsilateral breast tumour recurrence

Background
Knowledge of regional lymph node involvement is important in patients with recurrent breast cancer for obtaining better locoregional control and predicting prognosis. To determine technical feasibility, validity, aberrant drainage rates, and clinical consequences of performing repeat sentinel node biopsy (SNB) in patients with locally recurrent breast cancer we conducted the “Sentinel Node and Recurrent Breast Cancer (SNARB)” study.

Sentinel Node and Recurrent Breast Cancer (SNARB): Results of a Nationwide Registration Study

Background
Prior ipsilateral completion axillary lymph node dissection (CALND) may be considered a contraindication to performing a sentinel lymph node (SLN) mapping in a patient with recurrent breast carcinoma. However, reoperative SLN biopsy following axillary dissection would determine if alternative lymphatic drainage pathways exist. If nodes were found to contain metastatic disease, staging and locoregional control of the disease could be affected.

54de la recherche du ganglion sentinelle en cas de rechute locale

References

Reoperative sentinel lymph node biopsy: a new frontier in the management of ipsilateral breast tumor recurrence.

Second axillary sentinel node biopsy for ipsilateral breast tumour recurrence

Sentinel Node and Recurrent Breast Cancer (SNARB): Results of a Nationwide Registration Study

Sentinel lymph node biopsy in patients with previous ipsilateral complete axillary lymph node dissection.