Re-sentinel node biopsy after previous breast and axillary surgery.

There is no consensus regarding the strategy for managing the regional lymph nodes in patients with local breast cancer recurrence. This paper reviews the updated data on re-sentinel lymph node biopsy (re-SLNB) after previous surgery. The identification rate of re-SLNB varied from 29 to 100 % (mean 67 %). The success rate of re-SLNB depends on the method used for the previous axillary surgery and the number of lymph nodes harvested. Re-SLNB may be feasible even after mastectomy. A relationship between post-operative radiotherapy and identification of re-SLNB was not seen. A longer disease-free interval may correlate with a lower identification rate, but this finding is not definitive. Based on data regarding back-up dissection after re-SLNB, the accuracy of re-SLNB may be as good as SLNB in primary cases. Altered lymphatic drainage was reported in 2-89 % (mean 32 %) of cases. Because the altered lymphatic drainage can be detected only by lymphoscintigraphy, the radioisotope method, followed by lymphoscintigraphy, should be used. There are not many reported cases of axillary recurrence after re-SLNB, and the follow-up periods have been short. Because re-SLNB cases have a wide variety of backgrounds, it is necessary to accumulate a larger number of cases and to obtain data from longer follow-up period in order to make clear recommendations.