Axillary recurrences after negative sentinel lymph node biopsy under local anaesthesia for breast cancer: A follow-up study after 5 years

• Published in: European journal of surgical oncology 2009-02, Vol.35 (2), p.159-163
• Main Authors: Groetelaers, R.P.T.G.C, van Berlo, C.L.H, Nijhuis, P.H.A, Schapers, R.F.M, Gerritsen, H.A.M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia, Local - methods; Axilla; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Breast Neoplasms - secondary; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Incidence; Local anaesthesia; Lymph Nodes - pathology; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Netherlands - epidemiology; Retrospective Studies; Sentinel Lymph Node Biopsy - methods; Sentinel node procedure; Surgery; Time Factors
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2008.07.017

Abstract Introduction Sentinel lymph node biopsy (SLNB) is accepted as a standard surgical staging procedure for determining the tumour status of the regional lymph nodes. Until September 2000 we performed SLNB in general anaesthesia. Since 1999, after validation of the SLNB concept, axillary dissection was omitted in SLN-negative patients. This study presents our data after SLNB under local anaesthesia after a follow-up of at least 5 years. Materials and methods Between September 2000 and May 2003, 356 SLNBs were performed under local anaesthesia without sedation in patients with proven breast cancer (T4-tumours and small in situ carcinomas excluded) and without clinically or ultrasound guided cytological evidence of axillary node involvement. Lymphatic mapping and SLN identification were performed through the combination of blue dye and 99 m Tc-nanocolloid. All positive SLNs were followed by an axillary dissection up to level three. SLN-negative patients were followed without axillary clearance. Results In 353/356 SLNBs at least one sentinel node was found. 254/353 SLNs were tumour free. After a median follow-up of 73 months loco-regional and distant events were encountered in 10/353 SLNBs. Four patients (SLN-negative) showed tumour localization in the residual breast or chest wall (1.1%). Three patients (SLN-negative) presented with supraclavicular metastases (0.8%). In three patients (one SLN-negative and two SLN-positive followed by ALND) an axillary recurrence was encountered (0.8%). Conclusion This survey confirms the safety of the SLNB under local anaesthesia in selecting patients for axillary lymph node dissection in breast cancer.