Assessment of lymph node involvement in recurrent breast cancer: results of a nationwide registration study

In patients with recurrent breast cancer, knowledge of regional lymph node involvement serves as an important guide for disease prognosis and treatment decisions. The study presented here investigates the feasibility of “repeat sentinel node biopsy” (SNB) as a prognostic indicator instead of the more invasive “axillary (armpit) lymph node dissection” (ALND) procedure.

ALND is an important and effective cancer treatment for more advanced breast cancer.  It involves removing multiple lymph nodes from under the armpit. It not only removes the cancerous nodes, but it also removes surrounding nodes that could be cancerous as well. This method is not only painful, but can come with very disturbing side effects such as numbness, shoulder pain, limitation of motion, infection and lymphedema (when the arm swells). This swelling can often times be permanent. The study presented here investigated if lymphatic mapping (identifying lymph drainage patterns) in conjunction with a SNB can safely guide treatment choices (including the necessity of performing ALND). SNB involves identifying and only removing the first lymph node into which cancer could spread. 

150 patients with locally recurrent breast cancer, most of whom (96%) had previously undergone axillary cancer staging – either by SNB (33.3%) or ALND (62.7%) were included in this study. Lymphatic mapping was successfully performed in 95 patients (63.3%) and a repeat SNB was successfully performed in 79 of these 95 patients (83.2%).

77.2% of the retrieved sentinel nodes were negative (cancer had not spread to nearby lymph nodes), 11.4% showed a micrometastasis and 11.4% had a macrometastasis (visible metastasis). In addition, a confirmation ALND was performed in 18 patients after a previous node-negative SNB and no metastases were found. Treatment was adjusted based on the outcome of the repeat SNB and patients with node-negative SNB could be spared the more invasive ALND treatment .

In addition, the analysis of lymphatic drainage patterns revealed that aberrant lymphatic drainage was much more common in patients who had a previous ALND (79.3%) compared to patients with a previous SNB (25%). The relevance of aberrant drainage patterns in breast cancer progression is currently under investigation. ALND appears likely to contribute to the establishment of aberrant lymphatic drainage patterns.

The study found that the risk of axillary recurrence (cancer spreading to armpit lymph nodes) after a negative sentinel node biopsy is very low and the more invasive ALND treatment option can safely be omitted.

Ask your doctor about the option of the less invasive option of a repeat SNB as a safe alternative to an ALND.