Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Eur J Surg Oncol. 2024 Nov;50(11):108644. doi: 10.1016/j.ejso.2024.108644. Epub 2024 Aug 30.
Ipsilateral breast tumor recurrence (IBTR) remains a concern despite standard treatments. Advances in early detection have shifted surgical paradigms towards less invasive approaches. While repeat sentinel lymph node biopsy (rSLNB) emerges as a viable option according to the 2023 National Comprehensive Cancer Network (NCCN) guidelines, its efficacy remains uncertain. This study aimed to assess lymphatic drainage patterns in IBTR and evaluate the feasibility of rSLNB, along with analyzing oncologic outcomes.
A retrospective analysis involving 78 patients with IBTR who had prior breast-conserving surgery (BCS) with sentinel lymph node biopsy (SLNB) and adjuvant whole breast irradiation (WBI) at Samsung Medical Center was conducted. Data on patient characteristics, lymphatic mapping techniques, and oncologic outcomes were collected and analyzed.
Among 78 patients with IBTR, 82.1 % underwent successful rSLNB, predominantly detecting lymphatic drainage to the ipsilateral axilla (80.8 %). The initial tumor location correlated significantly with failed lymphatic mapping (p = 0.019). A third event occurred in 28.8 % of invasive IBTR cases, notably associated with postmenopausal status, higher T stages, and HR(-)/HER2(-) subtype (p < 0.001). The risk of a third event increased by over 50 % within a 2-year interval post-IBTR.
rSLNB in patients with IBTR, particularly for tumors initially located outside the upper-outer quadrant, demonstrated technical feasibility. The combined use of blue dye with lymphoscintigraphy may enhance rSLNB success rates. Active surveillance, especially for triple negative IBTR cases, may be important due to their aggressive nature and rapid progression potential within a short interval post-IBTR.
尽管采用了标准治疗方法，同侧乳房肿瘤复发（IBTR）仍然令人担忧。早期检测技术的进步使手术模式向创伤更小的方法转变。根据 2023 年美国国家综合癌症网络（NCCN）指南，重复前哨淋巴结活检（rSLNB）成为一种可行的选择，但其疗效仍不确定。本研究旨在评估 IBTR 的淋巴引流模式，并评估 rSLNB 的可行性，同时分析肿瘤学结果。
对在三星医疗中心接受过保乳手术（BCS）加前哨淋巴结活检（SLNB）和辅助全乳照射（WBI）后出现同侧乳房肿瘤复发（IBTR）的 78 例患者进行回顾性分析。收集并分析了患者特征、淋巴示踪技术和肿瘤学结果的数据。
在 78 例 IBTR 患者中，82.1%的患者成功进行了 rSLNB，主要检测到同侧腋窝的淋巴引流（80.8%）。初始肿瘤位置与淋巴示踪失败显著相关（p=0.019）。3 例浸润性 IBTR 病例发生了第三次事件，绝经后状态、较高的 T 分期和 HR（-）/HER2（-）亚型与第三次事件显著相关（p<0.001）。IBTR 后 2 年内，第三次事件的风险增加了 50%以上。
IBTR 患者的 rSLNB ，特别是对于初始位于外上象限以外的肿瘤，具有技术可行性。蓝染料与淋巴闪烁显像术联合使用可能会提高 rSLNB 的成功率。由于其在 IBTR 后短时间内具有侵袭性和快速进展的潜力，主动监测，特别是对于三阴性 IBTR 病例，可能很重要。
