Management of the axilla for ipsilateral breast cancer recurrence after previous sentinel lymph node biopsy and breast conserving therapy

The sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in patients with primary breast cancer. Of these patients, 10–15% will develop local breast cancer recurrence. Optimal management of the axilla for these patients is still not established. The aim of this review is to assess the role of secondary lymph node biopsy in patients with ipsilateral breast cancer recurrence. The MEDLINE–PubMed databases were searched from 2006 to 2010 for publications addressing the role of secondary SLNB for ipsilateral breast cancer recurrence. Following terms were used: breast cancer recurrence, sentinel node biopsy, lymphatic drainage, follow-up lymphatic mapping. Twenty-two publications reporting a second SLNB at the time of ipsilateral relapse were identified. The detection rate of a new sentinel node (SN) was 45–97%. The detection rate varied depending on the type of previous surgery. A high rate of extra-axillary re-SN was reported (32%). In 8–35% cases, a histologically positive re-SN was diagnosed. The optimal management of the axilla in the setting of local recurrence is still not established. Prospective trials are needed to facilitate evidence-based recommendations for this situation.