Should you get a second sentinel lymph node biopsy?

This paper studied whether having a second sentinel lymph node biopsy (removal of tissue from the lymph node to assess for cancer cells) is beneficial for patients who have recurred despite a negative first sentinel lymph node biopsy and conservative surgery.

Sentinel lymph node biopsy is a procedure where the first lymph node to which cancer is most ikely to spread to is removed to determine if cancer cells are present. This avoids removing unnecessary lymph nodes and reduces risks. In patients who were previously treated with breast conserving therapy (surgery to remove part of breast) and had a negative initial sentinel lymph node biopsy (no cancer in lymph nodes), there are no specific biopsy guidelines if breast cancer returns again. Several studies showed that a second lymph node biopsy can be successfully undertaken in patients with previously negative sentinel lymph node biopsy results.  

Data about 212 patients who previously had breast conserving surgery and negative sentinel lymph node biopsy were obtained. Patients with breast cancer recurrence (return of breast cancer) were offered a second sentinel lymph node biopsy. All the patients were examined every 6 months and underwent annual mammography.

92.5% of patients were able to successfully undergo a second sentinel lymph node biopsy. In 87% of patients, one or two sentinel lymph nodes were identified and removed.

At 5 years, the rate of axillary recurrence (return of cancer to the area around armpit) was 3.9%, while the rate of distant metastasis was 4.7%. At 5 years, the disease free survival rate (survival without symptoms of disease) was 79.9%. The overall survival at 5 years was 93.9%.

The authors concluded that a second sentinel lymph node biopsy should be considered for patients with breast tumor recurrence with previously negative sentinel lymph node biopsy. 

Consider having a second sentinel lymph node biopsy if you have local breast recurrence.