Axillary lymph node recurrence after negative sentinel lymph node biopsy for breast cancer

Abstract

Background......The report on the long term follow up of breast cancer in which axillary lymph node dissection (ALND) is spared because of negative sentinel lymph node biopsy (SLNB) indicates about 1% recurrence rate of cancer in the axillary lymph nodes (ALN). However, no detailed reports regarding the recurrence of cancer in the ALN are present so far. We studied this time the recurrence of cancer in the ALN after negative SLNB.
Materials and Methods......Among 670 cases of SLNB of breast cancer performed between Jan. 2000 and Dec. 2007, 566 cases showed negative results, and therefore ALND were spared. During the average follow up period of 40 months, 9 cases (1.6%) of recurrence of cancer in the ALN were observed. In these 9 cases, a study was done regarding to the background factors, treatment modalities and prognosis.
Results......Histopathological study revealed the presence of scirrhous carcinoma in all cases. Histological grade of malignancy was grade 3 in 6 cases (67%) and in 5 cases (56%) vascular invasions were seen. In 6 cases (67%), hormone receptors were negative. Recurrences occurred in average of 16.1 months and ALND were performed in all cases. In 4 cases, more than 7 ALN metastases were involved and in all cases supraclavicular lymph nodes or distant metastases were seen. In 5 cases with less than 3 ALN metastases, only one case showed supraclavicular metastasis and received radiation therapy resulting in CR and all the cases are alive without cancers.
Conclusion......The risk factors for the ALN recurrence were histological grade, presence of vascular invasions and negative hormone receptors. ALN recurrence with multiple positive nodes are prone to have other sites metastases and radiation therapy or chemotherapy should probably be indicated.