Sentinel lymph node biopsy in operations for recurrent breast cancer C.K. Axelsson a,b,c, * , P.-E. Jønsson d,e a Department of Breast Surgery, Herlev University Hospital, DK-2730 Herlev, Copenhagen, Denmark b Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, DK-2730 Herlev, Copenhagen, Denmark c Danish Breast Cancer Cooperative Group (DBCG), DBCG Secretariat, Rigshospitalet, DK-2100 CopenhagenØ, Denmark d Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden e Institution of Clinical Science, Malmo ¨ University Hospital, Malmo ¨, Sweden Accepted 10 September 2007 Available online 29 October 2007 Abstract Background: In a pilot prospective consecutive series on 50 patients with recurrent breast cancer, results of sentinel lymph node biopsy (SLNB) are reported. The interval between primary operation and recurrence was 8 years (range 1e18 years). Only three patients had not undergone dissection of the axilla (ALND). Results: In 51% of patients scintigraphy disclosed sentinel nodes (SN). At operation SN was identified in 45% of patients corresponding to 83% of the SN’s visualized by the scintigraphy. SN contained metastases in seven cases (16%), and the treatment plan was changed as a consequence of the SN examination. Conclusion: SLNB can identify SN at a high rate, and the findings may influence further planning of treatment. SLNB should be a future standard procedure in operations for recurrent breast cancer. Next step should be a randomized study. Ó 2007 Elsevier Ltd. All rights reserved. Keywords: Sentinel node; Breast cancer; Recurrence; Scintigraphy; Surgery Introduction The sentinel node biopsy (SLNB) is an accurate staging procedure of the axilla in primary breast cancer. 1 The stan- dard surgery in patients with local breast cancer recurrence is either an excision of the recurrent tumour or mostly a sal- vage mastectomy with no further surgery of the axilla after an earlier axillary lymph node dissection (ALND). The present report asks the following questions: (1) Has the pri- mary surgery and/or irradiation destroyed or changed the lymphatic drainage to the axilla? (2) What information is obtained from SNLB in locally recurrent breast cancer? (3) Is the treatment affected? Materials and methods Patients From 0ctober 2003 until 2006, 50 patients with local recurrent breast cancer were included in the study. The Ethics Committee in Copenhagen County approved the protocol. Informed consent was obtained before inclu- sion. The patient series is prospective and consecutive, and only two patients did not accept inclusion in the protocol. Case material After inclusion protocol violations occurred; three pa- tients were excluded, as preoperative lymphoscintigraphy was not performed, leaving 47 patients in the scintigraphy study group. At operation, the surgeon did not inject Patent Blue and left the axilla untreated in six patients, as scintig- raphy was negative, leaving 44 patients in the surgical study group. Patient and clinical characteristics are pre- sented in Table 1. * Corresponding author: Department of Breast Surgery, F118, Herlev University Hospital, Ringvejen 75, DK-2730, Herlev, Denmark. Tel.: þ45 4488 4281. E-mail address: c.axelsson@dadlnet.dk (C.K. Axelsson). 0748-7983/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2007.09.004 Available online at www.sciencedirect.com EJSO 34 (2008) 626e630 www.ejso.com