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Added value of repeat sentinel lymph node biopsy in FDG-PET/CT node-negative patients with ipsilateral breast cancer recurrence

  • Epidemiology
  • Published:
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Abstract

Purpose

Repeat sentinel lymph node biopsy (rSLNB) has been suggested for axillary staging in clinically node-negative (cN0) patients with ipsilateral breast tumor recurrence (IBTR). Although rSLNB is technically feasible in this group of patients, the clinical value has not been established. We aimed to assess the added value of rSLNB in cN0 patients with IBTR who underwent optimal clinical staging with FDG-PET/CT.

Methods

This retrospective single-center cohort study included 119 patients with IBTR-staged cT1-4N0M0 with FDG-PET/CT who underwent rSLNB between 2006 and 2020. Overall recurrence-free survival (RFS) and overall survival (OS) were calculated for subgroups with tumor-positive, tumor negative, and unsuccessful rSLNB.

Results

rSLNB was successful in 79 (66%) of the 119 included patients, of whom 70 (59%) had a tumor negative and 9 (8%) a tumor-positive rSLNB; rSLNB was unsuccessful in the remaining 40 (34%) patients. Patients with a tumor-positive rSLNB had poorer overall 5-year RFS compared to patients with a tumor negative or unsuccessful rSLNB (44% vs. 86% vs. 90%, p = 0.004). Although patients with a tumor-positive rSLNB had worse RFS, the 10-year OS was comparable to a tumor negative or unsuccessful rSLNB (89% vs. 89% vs. 95%, p = 0.701).

Conclusion

The incidence of a tumor-positive rSLNB in patients with a negative FDG-PET/CT is low and does not change survival. Therefore, in cN0 patients with IBTR who underwent optimal clinical staging with FDG-PET/CT, we support a patient- and tumor-tailored treatment strategy in which rSLNB may be omitted.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

ALND:

Axillary lymph node dissection

FDG-PET/CT:

Fluorodeoxyglucose-Positron Emission Tomography/Computerized Tomography

FNA:

Fine-needle aspiration

FU:

Follow-up

Her2:

Human epidermal growth factor receptor 2

HR:

Hormone receptor

H&E:

Hematoxylin and eosin

IBTR:

Ipsilateral breast tumor recurrence

ICT:

Isolated tumor cells

LN:

Lymph node

MARI:

Marking of the Axilla with Radioactive Iodine seeds

MRI:

Contrast-enhanced magnetic resonance imaging

NKI-AVL:

The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital

NPV:

Negative predictive value

NST:

No special type

OS:

Overall survival

RFS:

Recurrence-free survival

(r)SLNB:

(Repeat) sentinel lymph node biopsy

SLN:

Sentinel lymph node

SNARB:

Dutch Sentinel Node and Recurrent Breast Cancer study

SPECT/CT:

Single-Photon Emission Computed Tomography/Computed Tomography

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Funding

This work was not supported by research grants.

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Author notes

  1. R. Haarsma and A. A. van Loevezijn both have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical Oncology, Antoni van Leeuwenhoek–Netherlands Cancer Institute, Plesnmanlaan 121, 1066CX, Amsterdam, The Netherlands

    R. Haarsma, A. A. van Loevezijn, M. T. F. D. Vrancken Peeters & F. H. van Duijnhoven

  2. Department of Surgical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands

    A. A. van Loevezijn & M. T. F. D. Vrancken Peeters

  3. Department of Nuclear Medicine, Netherlands Cancer Institute–Antoni van Leeuwenhoek, Amsterdam, The Netherlands

    M. L. Donswijk

  4. Department of Radiotherapy, Netherlands Cancer Institute- Antoni Van Leeuwenhoek, Amsterdam, The Netherlands

    A. N. Scholten

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Contributions

FHvD conceived and designed the study together with AAvL, MTFDVP, and RH. Material preparation, data collection, and analysis were performed by RH, AAvL, and MD. The first draft of the manuscript was written by RH, AAvL, and FHvD, and all authors commented on previous versions of the manuscript and approved the final version of the manuscript. RH and AAvL contributed equally to this manuscript and share first authorship.

Corresponding author

Correspondence to F. H. van Duijnhoven.

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Conflicts of interest

All authors declare no competing interests.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The institutional review board of the Netherlands Cancer Institute approved this study.

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This study was conducted retrospectively from data obtained for clinical purposes. An official waiver of ethical approval was granted from the institutional review board.

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Haarsma, R., van Loevezijn, A.A., Donswijk, M.L. et al. Added value of repeat sentinel lymph node biopsy in FDG-PET/CT node-negative patients with ipsilateral breast cancer recurrence. Breast Cancer Res Treat 194, 617–627 (2022). https://doi.org/10.1007/s10549-022-06654-9

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