The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection

A follow-up study of 4008 procedures

Arpana Naik, Jane Fey, Mary Gemignani, Alexandra Heerdt, Leslie Montgomery, Jeanne Petrek, Elisa Port, Virgilio Sacchini, Lisa Sclafani, Kimberly VanZee, Raquel Wagman, Patrick I. Borgen, Hiram S. Cody, Kirby I. Bland, Merrick I. Ross, Stanley P L Leong, Monica Morrow, Steven M. Strasberg

Research output: Contribution to journalArticle

343 Citations (Scopus)

Abstract

Objective: We sought to identify the rate of axillary recurrence after sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: SLN biopsy is a new standard of care for axillary lymph node staging in breast cancer. Nevertheless, most validated series of SLN biopsy confirm that the SLN is falsely negative in 5-10% of node-positive cases, and few studies report the rate of axillary local recurrence (LR) for that subset of patients staged by SLN biopsy alone. Methods: Through December of 2002, 4008 consecutive SLN biopsy procedures were performed at Memorial Sloan-Kettering Cancer Center for unilateral invasive breast cancer. Patients were categorized in 4 groups: SLN-negative with axillary lymph node dissection (ALND; n = 326), SLN-negative without ALND (n = 2340), SLN-positive with ALND (n = 1132), and SLN-positive without ALND (n = 210). Clinical and pathologic characteristics and follow-up data for each of the 4 cohorts were evaluated with emphasis on patterns of axillary LR. Results: With a median follow-up of 31 months (range, 1-75), axillary LR occurred in 10/4008 (0.25%) patients overall. In 3 cases (0.07%) the axillary LR was the first site of treatment failure, in 4 (0.1%) it was coincident with breast LR, and in 3 (0.07%) it was coincident with distant metastases. Axillary LR was more frequent among the unconventionally treated SLN-positive/no ALND patients than in the other 3 conventionally treated cohorts (1.4% versus 0.18%, P = 0.013). Conclusions: Axillary LR after SLN biopsy, with or without ALND, is a rare event, and this low relapse rate supports wider use of SLN biopsy for breast cancer staging. There is a low-risk subset of SLN-positive patients in whom completion ALND may not be required.

Original languageEnglish (US)
Pages (from-to)462-471
Number of pages10
JournalAnnals of Surgery
Volume240
Issue number3
DOIs
StatePublished - Sep 2004
Externally publishedYes

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Sentinel Lymph Node Biopsy
Lymph Node Excision
Breast Neoplasms
Recurrence
Neoplasm Staging
Standard of Care
Sentinel Lymph Node
Treatment Failure
Breast
Lymph Nodes
Neoplasm Metastasis

ASJC Scopus subject areas

  • Surgery

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The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection : A follow-up study of 4008 procedures. / Naik, Arpana; Fey, Jane; Gemignani, Mary; Heerdt, Alexandra; Montgomery, Leslie; Petrek, Jeanne; Port, Elisa; Sacchini, Virgilio; Sclafani, Lisa; VanZee, Kimberly; Wagman, Raquel; Borgen, Patrick I.; Cody, Hiram S.; Bland, Kirby I.; Ross, Merrick I.; Leong, Stanley P L; Morrow, Monica; Strasberg, Steven M.

In: Annals of Surgery, Vol. 240, No. 3, 09.2004, p. 462-471.

Research output: Contribution to journalArticle

Naik, A, Fey, J, Gemignani, M, Heerdt, A, Montgomery, L, Petrek, J, Port, E, Sacchini, V, Sclafani, L, VanZee, K, Wagman, R, Borgen, PI, Cody, HS, Bland, KI, Ross, MI, Leong, SPL, Morrow, M & Strasberg, SM 2004, 'The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: A follow-up study of 4008 procedures', Annals of Surgery, vol. 240, no. 3, pp. 462-471. https://doi.org/10.1097/01.sla.0000137130.23530.19
Naik, Arpana ; Fey, Jane ; Gemignani, Mary ; Heerdt, Alexandra ; Montgomery, Leslie ; Petrek, Jeanne ; Port, Elisa ; Sacchini, Virgilio ; Sclafani, Lisa ; VanZee, Kimberly ; Wagman, Raquel ; Borgen, Patrick I. ; Cody, Hiram S. ; Bland, Kirby I. ; Ross, Merrick I. ; Leong, Stanley P L ; Morrow, Monica ; Strasberg, Steven M. / The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection : A follow-up study of 4008 procedures. In: Annals of Surgery. 2004 ; Vol. 240, No. 3. pp. 462-471.
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title = "The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: A follow-up study of 4008 procedures",
abstract = "Objective: We sought to identify the rate of axillary recurrence after sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: SLN biopsy is a new standard of care for axillary lymph node staging in breast cancer. Nevertheless, most validated series of SLN biopsy confirm that the SLN is falsely negative in 5-10{\%} of node-positive cases, and few studies report the rate of axillary local recurrence (LR) for that subset of patients staged by SLN biopsy alone. Methods: Through December of 2002, 4008 consecutive SLN biopsy procedures were performed at Memorial Sloan-Kettering Cancer Center for unilateral invasive breast cancer. Patients were categorized in 4 groups: SLN-negative with axillary lymph node dissection (ALND; n = 326), SLN-negative without ALND (n = 2340), SLN-positive with ALND (n = 1132), and SLN-positive without ALND (n = 210). Clinical and pathologic characteristics and follow-up data for each of the 4 cohorts were evaluated with emphasis on patterns of axillary LR. Results: With a median follow-up of 31 months (range, 1-75), axillary LR occurred in 10/4008 (0.25{\%}) patients overall. In 3 cases (0.07{\%}) the axillary LR was the first site of treatment failure, in 4 (0.1{\%}) it was coincident with breast LR, and in 3 (0.07{\%}) it was coincident with distant metastases. Axillary LR was more frequent among the unconventionally treated SLN-positive/no ALND patients than in the other 3 conventionally treated cohorts (1.4{\%} versus 0.18{\%}, P = 0.013). Conclusions: Axillary LR after SLN biopsy, with or without ALND, is a rare event, and this low relapse rate supports wider use of SLN biopsy for breast cancer staging. There is a low-risk subset of SLN-positive patients in whom completion ALND may not be required.",
author = "Arpana Naik and Jane Fey and Mary Gemignani and Alexandra Heerdt and Leslie Montgomery and Jeanne Petrek and Elisa Port and Virgilio Sacchini and Lisa Sclafani and Kimberly VanZee and Raquel Wagman and Borgen, {Patrick I.} and Cody, {Hiram S.} and Bland, {Kirby I.} and Ross, {Merrick I.} and Leong, {Stanley P L} and Monica Morrow and Strasberg, {Steven M.}",
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T1 - The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection

T2 - A follow-up study of 4008 procedures

AU - Naik, Arpana

AU - Fey, Jane

AU - Gemignani, Mary

AU - Heerdt, Alexandra

AU - Montgomery, Leslie

AU - Petrek, Jeanne

AU - Port, Elisa

AU - Sacchini, Virgilio

AU - Sclafani, Lisa

AU - VanZee, Kimberly

AU - Wagman, Raquel

AU - Borgen, Patrick I.

AU - Cody, Hiram S.

AU - Bland, Kirby I.

AU - Ross, Merrick I.

AU - Leong, Stanley P L

AU - Morrow, Monica

AU - Strasberg, Steven M.

PY - 2004/9

Y1 - 2004/9

N2 - Objective: We sought to identify the rate of axillary recurrence after sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: SLN biopsy is a new standard of care for axillary lymph node staging in breast cancer. Nevertheless, most validated series of SLN biopsy confirm that the SLN is falsely negative in 5-10% of node-positive cases, and few studies report the rate of axillary local recurrence (LR) for that subset of patients staged by SLN biopsy alone. Methods: Through December of 2002, 4008 consecutive SLN biopsy procedures were performed at Memorial Sloan-Kettering Cancer Center for unilateral invasive breast cancer. Patients were categorized in 4 groups: SLN-negative with axillary lymph node dissection (ALND; n = 326), SLN-negative without ALND (n = 2340), SLN-positive with ALND (n = 1132), and SLN-positive without ALND (n = 210). Clinical and pathologic characteristics and follow-up data for each of the 4 cohorts were evaluated with emphasis on patterns of axillary LR. Results: With a median follow-up of 31 months (range, 1-75), axillary LR occurred in 10/4008 (0.25%) patients overall. In 3 cases (0.07%) the axillary LR was the first site of treatment failure, in 4 (0.1%) it was coincident with breast LR, and in 3 (0.07%) it was coincident with distant metastases. Axillary LR was more frequent among the unconventionally treated SLN-positive/no ALND patients than in the other 3 conventionally treated cohorts (1.4% versus 0.18%, P = 0.013). Conclusions: Axillary LR after SLN biopsy, with or without ALND, is a rare event, and this low relapse rate supports wider use of SLN biopsy for breast cancer staging. There is a low-risk subset of SLN-positive patients in whom completion ALND may not be required.

AB - Objective: We sought to identify the rate of axillary recurrence after sentinel lymph node (SLN) biopsy for breast cancer. Summary Background Data: SLN biopsy is a new standard of care for axillary lymph node staging in breast cancer. Nevertheless, most validated series of SLN biopsy confirm that the SLN is falsely negative in 5-10% of node-positive cases, and few studies report the rate of axillary local recurrence (LR) for that subset of patients staged by SLN biopsy alone. Methods: Through December of 2002, 4008 consecutive SLN biopsy procedures were performed at Memorial Sloan-Kettering Cancer Center for unilateral invasive breast cancer. Patients were categorized in 4 groups: SLN-negative with axillary lymph node dissection (ALND; n = 326), SLN-negative without ALND (n = 2340), SLN-positive with ALND (n = 1132), and SLN-positive without ALND (n = 210). Clinical and pathologic characteristics and follow-up data for each of the 4 cohorts were evaluated with emphasis on patterns of axillary LR. Results: With a median follow-up of 31 months (range, 1-75), axillary LR occurred in 10/4008 (0.25%) patients overall. In 3 cases (0.07%) the axillary LR was the first site of treatment failure, in 4 (0.1%) it was coincident with breast LR, and in 3 (0.07%) it was coincident with distant metastases. Axillary LR was more frequent among the unconventionally treated SLN-positive/no ALND patients than in the other 3 conventionally treated cohorts (1.4% versus 0.18%, P = 0.013). Conclusions: Axillary LR after SLN biopsy, with or without ALND, is a rare event, and this low relapse rate supports wider use of SLN biopsy for breast cancer staging. There is a low-risk subset of SLN-positive patients in whom completion ALND may not be required.

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