Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Eur J Surg Oncol. 2010 Jul;36(7):646-51. doi: 10.1016/j.ejso.2010.05.009. Epub 2010 May 26.
To evaluate axillary staging and management in patients with local recurrence (LR) after a previous negative sentinel lymph node biopsy (SNB).
Between 1999 and 2008, 130 patients with previous negative SNB developed a LR of breast or chest wall. After examination of clinical records, 70 patients met the inclusion criteria and remained available for analysis.
Thirty-seven patients were treated with axillary lymph node dissection (ALND), followed by axillary radiotherapy in 9 cases. In 26 of these 37 patients no positive axillary lymph nodes were found. Nineteen patients received no treatment of the axilla at all. Of those, 9 were older than 70 years of age at diagnosis of LR. In 13 patients a second SNB was attempted, but was successful in only 5 cases. Eight patients underwent a complementary ALND. Overall, positive lymph nodes were detected in 13 of the 50 patients who underwent axillary staging, either by SNB or ALND. The median length of follow-up of the 70 patients following their diagnosis of LR was 24 months (range 2-81 months). During this follow-up period one patient developed an axillary recurrence. This was a patient who refused to undergo ALND but was given locoregional radiotherapy instead.
In the absence of guidelines for staging and management of the axilla at time of LR of breast or chest wall, many different strategies are being used. Considering the high rate of positive axillary lymph nodes in these patients, repeat surgical staging is appropriate.
评估既往阴性前哨淋巴结活检（SNB）后局部复发（LR）患者的腋窝分期和管理。
1999 年至 2008 年间，130 例先前 SNB 阴性的患者出现乳腺或胸壁 LR。在检查临床记录后，70 例符合纳入标准并可进行分析。
37 例患者接受了腋窝淋巴结清扫术（ALND），其中 9 例随后进行了腋窝放疗。在这 37 例患者中，有 26 例未发现阳性腋窝淋巴结。19 例患者根本未对腋窝进行任何治疗，其中 9 例在诊断 LR 时年龄大于 70 岁。在 13 例患者中尝试进行了第二次 SNB，但仅在 5 例中成功。8 例患者接受了补充性 ALND。总的来说，在接受腋窝分期的 50 例患者中，有 13 例通过 SNB 或 ALND 检测到阳性淋巴结。70 例患者在诊断为 LR 后的中位随访时间为 24 个月（范围为 2-81 个月）。在随访期间，1 例患者发生腋窝复发。这是一位拒绝接受 ALND 但接受局部区域放疗的患者。
在没有针对乳腺或胸壁 LR 时的腋窝分期和管理指南的情况下，许多不同的策略正在被使用。考虑到这些患者中阳性腋窝淋巴结的高发生率，重复手术分期是合适的。
