Results of sentinel node biopsy not affected by previous excisional biopsy

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Abstract

Aims

Sentinel lymph node (SN) biopsy has been validated in the treatment of breast carcinoma. Patients with previous excisional biopsy are regarded as ineligible for SN biopsy. We evaluated the results of SN biopsy for this group of patients based on confirmatory axillary lymph node dissection.

Patients and methods

From April 1997 all 88 patients with stage T1—3 breast cancer who had previously undergone diagnostic excisional biopsy followed by complete axillary lymph node dissection, were enrolled into a prospective study to determine the validity of the sentinel node procedure.

Results

Lymphoscintigraphy visualized one or more axillary hot spots in 84/88 patients. A successful SN biopsy was performed in 87 patients. Complete axillary lymph-node dissection showed no false-negative SN biopsy among the 87 SN procedures.

Conclusion

SN biopsy is a reliable and safe method following excisional biopsy as is confirmed by completion axillary lymph node dissection. Therefore, patients with previous excisional biopsy are eligible for sentinel node procedure and can be spared unnecessary axillary lymph node dissection.

Introduction

Sentinel node (SN) biopsy is a widely adopted technique for nodal staging in breast cancer.1, 2, 3 As compared to axillary lymph node dissection (ALND), it provides similar staging information, with less morbidity. When performed by an experienced surgeon, sensitivity of SN biopsy is in excess of 95%.4, 5, 6, 7, 8, 9, 10 Therefore, a negative SN biopsy accurately predicts the absence of nodal tumour involvement in the axilla and justifies avoidance of complete ALND.

Controversy persists about the accuracy of SN biopsy following previous excisional biopsy. It is assumed that the lymphatic drainage pattern is altered in these patients, resulting in less accurate lymphatic mapping and unreliable results of the SN biopsy.3, 11 If this hypothesis is correct, then a number of breast cancer patients will be deprived of the advantages of the SN technique.

To date there are no published validation studies in which the reliability of the SN procedure in breast cancer patients following previous diagnostic excisional biopsy is investigated by performing a completion axillary lymph node dissection. For this study we reviewed the relevant data in our large prospective database on SN biopsy, to determine the accuracy of the procedure in this selected group of patients.

Section snippets

Patients and methods

We analysed all of our patients with stage T1—3 breast cancer, who had undergone diagnostic excisional biopsy prior to SN biopsy (group A). In this group 88 patients were operated in a period from April 1997 until January 2000 with approval of the local ethical committee and after obtaining informed consent. All group A patients underwent SN biopsy followed by a complete axillary lymph node dissection. All operative procedures were performed by two surgeons experienced in SN biopsies. In the

Results

In all, 88 consecutive patients with previous excisional biopsy (group A) were included in this study. Patient characteristics are listed in Table 1. Tumour size was pT1 in 58 patients, pT2 in 27 patients and pT3 in 3 patients. The average tumour size was 15 mm (range 3–70 mm). The primary tumour was located in the lateral quadrants in 55 patients, of which 26 tumours were in the upper-outer quadrant.

Lymphoscintigraphy visualized one or more axillary hot spots in 84/88 patients (Table 2). A

Discussion

Because of its high sensitivity and its minimally invasive nature, SN biopsy has replaced ALND as the primary procedure for axillary staging in breast cancer in many centers. However, various exclusion criteria have been formulated by different investigators. One of these exclusion criteria is a previous excisional biopsy.3, 6, 13 Prior surgery is assumed to alter the lymphatic drainage patterns by disrupting the lymphatic channels, thus preventing the surgeon from performing accurate lymphatic

Conclusion

Sentinel node biopsy for breast cancer following previous excisional biopsy is accurate for axillary lymph node staging, as is confirmed by completion axillary lymph node dissection in this study. Localisation of the biopsy, even in the upper outer quadrant, does not affect identification of the axillary sentinel node. Moreover, visualization and identification of internal mammary sentinel nodes is not impaired. Therefore, patients with previous excisional biopsy are eligible for the sentinel

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