Sentinel Lypmh Node Biopsy in the Setting of Previous Ipsilateral Breast or Axillary Operation

  • Although there are no randomized data:
    • Multiple retrospective and observational studies:
      • Have evaluated SLNB in patients who have had previous breast or axillary operations
  • Previous breast conservation or excisional biopsy:
    • Does not appear to affect the accuracy of the SLN biopsy
  • Completion ALND:
    • Has been routinely recommended for all patients:
      • With local recurrence:
        • However, 60% to 90% of such patients:
          • Are node negative
    • Reoperative SLNB:
      • Has been shown to be accurate after local recurrence:
        • And spares some patients from an unnecessary ALND
  • Successful identification of a sentinel node:
    • However, is inversely related to the number of nodes removed during the initial operation:
      • One study evaluating SLNB after previous axillary operations:
        • Reported successful sentinel lymph node identification in:
          • 68% of patients with less than nine nodes removed previously:
            • But only 38% in patients with nine or more nodes previously excised
    • Rates of extra-axillary sentinel node localization:
      • Range from 8% to 63% in patients:
        • With previous axillary operations
      • Patients who had a previous ALND:
        • Have the highest rates of extra-axillary localization:
          • Preoperative lymphoscintigraphy:
            • In addition to blue dye is recommended for SLNB after previous axillary operation to aid in localization and identification of extra-axillary drainage

#Arrangoiz #BreastSurgeon #BreastExpert #BreastCancer #CancerSurgeon #SurgicalOncologist #MountSinaiMedicalCenter #MSMC #Miami #Mexico #SLNM #SLNB #SentinelLymphNodeBiospy

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