Sentinel Lymph Node Procedure in Ipsilateral Invasive Breast Cancer Relapse

Sentinel lymph node biopsy (SLNB) has become the standard procedure for staging of patients with clinically node-negative breast cancer. Breast-conserving surgery (BCS) has also been a standard treatment for patients with early breast cancer. However, approximately 10% of patients with BCS develop ipsilateral breast tumor recurrence (IBTR), and mastectomy or resection of the recurrent tumor is generally performed. There are no specific guidelines available regarding staging and treatment of the regional lymph nodes. However, the reported risk of axillary lymph node metastasis among patients with local recurrence after breast surgery and a previous negative sentinel node biopsy of 26 % is too high to be ignored. Moreover, evaluation of the regional lymph node basins might be helpful to decide on the indication for adjuvant radiotherapy and systemic treatment. For these reasons it seems sensible to perform a regional lymph node staging procedure in patients with locally recurrent breast cancer. In general practice, this would mean that patients with recurrent breast cancer and a previous negative sentinel node biopsy would receive an axillary lymph node dissection (ALND) and that patients with a previous ALND would receive no additional axillary staging. Lymphatic drainage after previous breast surgery and/or radiotherapy would be altered and it remains questionable whether SLNB at the time of surgery for IBTR (second SLNB) is technically feasible and ALND can safely be omitted. In this study, investigators propose for all patients the realization of SLNB procedure and systematically ALND whatever the results of SLNB analysis, only on patients previously treated with breast conservative surgery. The aim of this study is to evaluate on a homogeneous prospective multicentric cohort of patients the feasibility and the accuracy of a second SLNB procedure for IBTR.

Minimum age

18 Years

Inclusion Criteria:

1. Patients ≥ 18 years old
2. Invasive recurrence (ductal, lobular, other), homolateral breast carcinoma
3. Size of the tumor with ultrasound ≤ 5cm
4. Initial conservative surgery
5. Patient who has already received SLND for her initial cancer, regardless of the SLND result
6. Procedure for the detection of lymph node sentinel by isotopic method +/- colorimetric
7. Minimum delay of one year between the end of radiotherapy for initial breast carcinoma and the treatment / management of ipsilateral recurrence
8. Pregnancy test (urinary or blood) negative for premenopausal patients
9. Information of the patient and obtaining written consent, signed by the patient and the investigator

Exclusion Criteria:

1. Non-invasive recurrence
2. History of ipsilateral axillary dissection
3. History of ipsilateral mastectomy
4. Patient pN + before surgery
5. Metastasis
6. Allergy known to 2 detection products (Blue and radioactive tracer)
7. Pregnant or lactating woman
8. Patient protected or under guardianship or unable to give consent
9. Impossibility of submitting to the medical examination for geographical, social or psychological reasons