Does duration to ipsilateral breast tumor recurrence affect the success of reoperative sentinel lymph node biopsy?. (2016) - Kuwajerwala, Nafisa
Abstract: Background: Five to ten percent of patients with prior breast cancer treated with breast conservation therapy (BCT) will develop ipsilateral breast tumor reoccurrence (IBTR), requiring reoperative sentinel lymph node biopsy (SNLB). IBTR patients may have a history of prior axillary surgery, which can be a SLNB or an axillary lymph node dissection (ALND). Materials & Methods: A retrospective chart review was conducted on patients with IBTR who received care in the Department of Surgery at William Beaumont Hospital, Royal Oak and Troy, Michigan, from January 2007 to December 2009. Results: Twenty-eight patients were identified and categorized as Prior ALND (>10 lymph nodes, n =14), Prior SLNB (≤10 lymph nodes, n =10) and an Unknown number of lymph nodes ( n =4). Among Prior ALND patients, reoperative SLNB success was increased in the ≥10 years group (25% vs. 50%, p =0.58). Similarly, among Prior SLNB patients, reoperative SLNB success was increased in the ≥10 years group (71% vs. 100%, p =1.0). Conclusion: Increased duration to IBTR may be associated with success of reoperative SNLB in patients with IBTR with prior ALND or SNLB. Further study is required to better understand this relationship. Microabstract: The relationship between timing of and success of reoperative sentinel lymph node biopsy (SLNB) has not been studied. We conducted an observational, retrospective analysis of 28 patients with ipsilateral breast tumor recurrence (IBTR). Our results may suggest a higher rate of reoperative SNLB success with increased (≥10 years) duration to IBTR among patients who initially underwent breast conserving therapy with initial axillary lymph node dissection or SNLB. Further research is required to characterize this potential relationship. Clinical practice points: Specific mechanisms for the regeneration of lymphatic channels in patients with IBTR after original SLNB or ALND are currently being investigated. The time necessary to reestablish significant lymphatic networks is unknown, but likely impacts the success of reoperative SNLB in ITBR patients. Our results may suggest a higher rate of reoperative SNLB success with increased (≥10 years) duration to IBTR among patients who initially underwent BCT with original axillary lymph node dissection or SNLB. Although more advanced research is required to better understand the relationship between timing of and success of reoperative SLNB, the results of this study may suggest that the utility of SLNB may be greater with increased length to IBTR. As a result, clinicians should be somewhat skeptical of the success of SLNB in patients with immediate IBTR until further research can be conducted.