Detection of axillary lymph node recurrence in patients with personal history of breast cancer treated with sentinel lymph node biopsy (SLNB): results of postoperative combined ultrasound and mammography screening over five consecutive years

Abstract

Background

Sentinel lymph node biopsy (SLNB) has been accepted as the standard treatment for axillary evaluation for invasive breast cancer with a clinically negative axilla and the low rate of recurrence after SLNB was reported.

Purpose

To evaluate the performance of screening ultrasound (US) for breast and axillary recurrence detection in breast cancer patients who underwent SLNB.

Material and Methods

We identified 2807 examinations of 562 breast cancer patients who underwent SLNB and received annual screening US combined with mammography (MG) for five years. The cancer detection rate, recall rate, and positive predictive value (PPV₃) of biopsies in breasts and breast plus axillae were calculated separately.

Results

During the five-year follow-up period, 21 patients had recurrences of breast cancer (9.8 per 1000 person-year; 95% confidence interval [CI] = 6.0–14.9), including three axillary recurrences (1.4 per 1000 person-year; 95% CI = 0.3–4.1). Screening breast US detected 12 breast cancers. The axillary scanning detected none of the axillary recurrences, but yielded 11.8 recalls per 1000 US screenings; the PPV₃ for the breast and breast plus axillae were 18.3% and 15.1%, respectively.

Conclusion

Axillary recurrence was very rare in patient who underwent SLNB; additional axillary scanning did not provide axillary recurrence detection, but only increased the number of false-positive recalls and biopsies.