• Mattia Intra, Giuseppe Trifirò, Giuseppe Viale, Nicole Rotmensz, Oreste D Gentilini, Javier Soteldo, Viviana Galimberti, Paolo Veronesi, Alberto Luini, Giovanni Paganelli, and Umberto Veronesi.
• Division of Breast Surgery, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy. mattia.intra@ieo.it
• Ann. Surg. Oncol. 2005 Nov 1;12(11):895-9.

BackgroundSentinel lymph node biopsy (SLNB) is a safe and accurate axillary staging procedure for patients with primary operable breast cancer. An increasing proportion of these patients undergo breast-conserving surgery, and 5% to 15% will develop local relapses that necessitate reoperation. Although a previous SLNB is often considered a contraindication for a subsequent SLNB, few data support this concern.MethodsBetween January 2000 and June 2004, 79 patients who were previously treated at our institution with breast-conserving surgery and who had a negative SLNB for early breast cancer developed, during follow-up, local recurrence that was amenable to reoperation. Eighteen of these patients were offered a second SLNB because of a clinically negative axillary status an average of 26.1 months after the primary event.ResultsIn all 18 patients (7 with ductal carcinoma-in-situ and 11 with invasive recurrences), preoperative lymphoscintigraphy showed an axillary sentinel lymph node, with a preoperative identification rate of 100%, and 1 or more SLNs (an average of 1.3 per patient) were surgically removed. Sentinel lymph node metastases were detected in two patients with invasive recurrence, and a complete axillary dissection followed. At a median follow up of 12.7 months, no axillary recurrences have occurred in patients who did not undergo axillary dissection.ConclusionsSecond SLNB after previous SLNB is technically feasible and likely effective in selected breast cancer patients. A larger population and longer follow-up are necessary to confirm these preliminary data.

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