• M Intra, G Trifirò, V Galimberti, O Gentilini, N Rotmensz, and P Veronesi.
• Division of Breast Surgery, European Institute of Oncology, Milan, Italy. mattia.intra@ieo.it
• Br J Surg. 2007 Oct 1; 94 (10): 1216-9.

BackgroundSentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in patients with primary operable breast cancer and uninvolved axillary nodes. These patients increasingly have breast-conserving surgery (BCS), and 5 to 10 per cent develop ipsilateral breast tumour recurrence during follow-up. If axillary nodes remain clinically uninvolved after a previous negative SLNB the question remains whether second SLNB is a suitable option.MethodsBetween January 2000 and October 2006, 202 patients who had previously had BCS and a negative SLNB developed an ipsilateral breast tumour recurrence. Of these, 65 women with clinically negative axillary nodes were offered a second SLNB; 57 had received adjuvant radiotherapy after BCS.ResultsIn 63 women, preoperative lymphoscintigraphy showed an axillary sentinel node (identification rate 97 per cent). In five, this was associated with extra-axillary migration. Sentinel node metastases were detected in seven women; in two this was the only metastasis. At a median follow-up of 45.9 months, no axillary recurrence had occurred in the women who had not had axillary dissection.ConclusionSecond SLNB after previous BCS and negative SLNB plus adjuvant radiotherapy may be offered to selected women with ipsilateral breast tumour recurrence.Copyright (c) 2007 British Journal of Surgery Society Ltd.

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