Cindy Matsen1, Kristine Villegas2, Anne Eaton3, Michelle Stempel2, Aidan Manning2, Hiram S Cody2, Monica Morrow2, Alexandra Heerdt2. 1. Breast Care Program, Department of Surgery, Hunstman Cancer Institute at the University of Utah, Salt Lake City, UT, USA. cindy.matsen@hsc.utah.edu. 2. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
BACKGROUND: This study was designed to determine the incidence of late axillary recurrence (AR) in patients with negative sentinel lymph node biopsy (SLNB) and provide a comparison with SLNB positive patients who underwent axillary lymph node dissection (ALND). METHODS: Retrospective analysis of prospectively collected data on all breast cancer patients with negative SLNB from January 1997 to December 2000 was performed on a large, institutional database. Primary outcome was cumulative incidence of AR as a first event with/without concurrent local recurrence. SLNB positive patients who went on to ALND during the same timeframe were comparatively analyzed. RESULTS: A total of 1529 eligible patients were identified (median age 58 years, median tumor size 1.0 cm): 1297 (85 %) underwent lumpectomy; 1099 (75 %) received adjuvant radiation; and 874 (80 %) were estrogen receptor-positive. At 10.8 (range 0-16) years median follow-up, overall incidence of AR as a first event was low (n = 13). Cumulative incidence was 0.6 % [95 % confidence interval (CI) 0.2-0.9] 5 years after SLNB, and 0.9 % (95 % CI 0.4-1.4, 95 % CI 0.5-1.6) at 10 and 15 years. Late AR (>5 years after surgery) occurred in five patients. Median overall survival after AR was 4.6 years; median distant disease-free survival after AR was 3.8 years. Late AR was also low in a contemporaneous group of SLNB positive patients undergoing ALND. In this group, cumulative incidence of AR was 0.7 % (95 % CI 0.1-1.3) 5 years after surgery, and 0.8 % (95 % CI 0.2-1.5) at 10 and 15 years. DISCUSSION: Late AR after negative SLNB is rare; the majority of ARs are in the first 5 years after surgery. Prognosis after these events is poor. SLNB remains a safe and effective procedure for axillary evaluation in breast cancer.
BACKGROUND: This study was designed to determine the incidence of late axillary recurrence (AR) in patients with negative sentinel lymph node biopsy (SLNB) and provide a comparison with SLNB positive patients who underwent axillary lymph node dissection (ALND). METHODS: Retrospective analysis of prospectively collected data on all breast cancerpatients with negative SLNB from January 1997 to December 2000 was performed on a large, institutional database. Primary outcome was cumulative incidence of AR as a first event with/without concurrent local recurrence. SLNB positive patients who went on to ALND during the same timeframe were comparatively analyzed. RESULTS: A total of 1529 eligible patients were identified (median age 58 years, median tumor size 1.0 cm): 1297 (85 %) underwent lumpectomy; 1099 (75 %) received adjuvant radiation; and 874 (80 %) were estrogen receptor-positive. At 10.8 (range 0-16) years median follow-up, overall incidence of AR as a first event was low (n = 13). Cumulative incidence was 0.6 % [95 % confidence interval (CI) 0.2-0.9] 5 years after SLNB, and 0.9 % (95 % CI 0.4-1.4, 95 % CI 0.5-1.6) at 10 and 15 years. Late AR (>5 years after surgery) occurred in five patients. Median overall survival after AR was 4.6 years; median distant disease-free survival after AR was 3.8 years. Late AR was also low in a contemporaneous group of SLNB positive patients undergoing ALND. In this group, cumulative incidence of AR was 0.7 % (95 % CI 0.1-1.3) 5 years after surgery, and 0.8 % (95 % CI 0.2-1.5) at 10 and 15 years. DISCUSSION: Late AR after negative SLNB is rare; the majority of ARs are in the first 5 years after surgery. Prognosis after these events is poor. SLNB remains a safe and effective procedure for axillary evaluation in breast cancer.
Authors: Bernard Fisher; Jong-Hyeon Jeong; Stewart Anderson; John Bryant; Edwin R Fisher; Norman Wolmark Journal: N Engl J Med Date: 2002-08-22 Impact factor: 91.245
Authors: E Tanis; C J H van de Velde; H Bartelink; M J van de Vijver; H Putter; J A van der Hage Journal: Eur J Cancer Date: 2012-03-23 Impact factor: 9.162
Authors: J J Albertini; G H Lyman; C Cox; T Yeatman; L Balducci; N Ku; S Shivers; C Berman; K Wells; D Rapaport; A Shons; J Horton; H Greenberg; S Nicosia; R Clark; A Cantor; D S Reintgen Journal: JAMA Date: 1996-12-11 Impact factor: 56.272
Authors: Stefan Aebi; Shari Gelber; Stewart J Anderson; István Láng; André Robidoux; Miguel Martín; Johan W R Nortier; Alexander H G Paterson; Mothaffar F Rimawi; José Manuel Baena Cañada; Beat Thürlimann; Elizabeth Murray; Eleftherios P Mamounas; Charles E Geyer; Karen N Price; Alan S Coates; Richard D Gelber; Priya Rastogi; Norman Wolmark; Irene L Wapnir Journal: Lancet Oncol Date: 2014-01-16 Impact factor: 41.316
Authors: Umberto Veronesi; Viviana Galimberti; Giovanni Paganelli; Patrick Maisonneuve; Giuseppe Viale; Roberto Orecchia; Alberto Luini; Mattia Intra; Paolo Veronesi; Pietro Caldarella; Giuseppe Renne; Nicole Rotmensz; Claudia Sangalli; Luciana De Brito Lima; Marco Tullii; Stefano Zurrida Journal: Eur J Cancer Date: 2009-01-06 Impact factor: 9.162