Axillary Recurrence after Negative Sentinel Lymph Node Dissection in Three Elderly Triple Negative Breast Cancer Patients
Meenal Sharma, Kristin A Skinner, David G Hicks, Ping Tang. University of Rochester Medical Center, Rochester, NY
Background: Sentinel lymph node dissection (SLND) is now a standard of care for breast cancer patients with clinically negative axillary nodes. The rates for axillary recurrence in SLN negative patients are negligible. Here we sought to investigate the clinicopathological features associated with axillary recurrence.
Design: Among approximately 1000 breast cancer patients treated in our institution with negative SLND in last 5 years, 3 cases had axillary recurrence. The SLN received 1) original evaluation - each node was evaluated by 2 levels of frozen sections and 2 levels of permanent HE sections and 1 level of IHC-CK. The interval betweeb each level was 50µm; and 2) Re-evaluation: we reviewed all original slides of frozen, permanent H&E, and IHC-CK sections. We then serially sectioned the entire remaining SLN with H&E and 2 levels of IHC-CK staining (ranging 27-150 levels per SLN). We reviewed the chart to document the treatment and follow up information of each patient.
Results: The ages of the patients were between 63-80 years. The intervals between the diagnosis of the primary tumor and the axillary recurrence were 17-20 months. All the 3 patients had infiltrating ductal carcinoma (IDC) of high nuclear grade, ranged 1-2.3 cm in size, and were ER, PR and HER2 negative. One patient with mastectomy received no radiation and chemotherapy. Two patients treated with BCT also received whole breast radiation (but axilla recurrences were outside of the radiation field). In one patient, the radiation field was suboptimal due to the presence of the pacemaker; this patient did received chemotherapy. In the other patient, axilla did not received radiation due to significant ptosis; this patient declined chemo therapy due to advance age. All 3 patients were on a 3 month follow up schedule. All three recurrences were detected by palpation. ALND were performed in all three cases, with metastatic tumor size ranging 1.9-4 cm and positive nodes at 6/16, 1/9, 3/16, respectively. We failed to identify any tumor cells in original frozen, H&E, IHC sections of the SLN. We also failed to identify any tumor cells in the remaining SLN after examining both the H&E and IHC-CK sections of the entire nodal tissue.
Conclusions: Axillary recurrence is a rare event. All cases in our study occurred in post-menopausal patients and received suboptimal therapy. Patients with aggressive features as such TN tumors, who are not receiving optimal treatment due to personal condition should be follow closely even in the setting of negative SLN.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 23, Wednesday Morning