Axillary recurrence after negative sentinel lymph node biopsy under local anesthesia in breast cancer

The procedure known as sentinel lymph node biopsy (SLNB) under local anesthesia (LA) allows surgical teams to avoid the uncertainties of frozen tissue examination and to perform axillary dissection on patients who have been informed of the risks of lymph node invasion prior to the procedure.ObjectiveIn the absence of studies that assess the risk of obtaining false negatives during SLNB under LA, we believed it would be relevant to do a study of the safety of SLNB under LA to ensure that the risk of axillary recurrence is as low as with SLNB carried out in the traditional manner under general anesthesia. Through the experience of the Department of Gynecological Surgery at the Limoges CHU, we were able to assess the risk of axillary recurrence after SLNB under LA.Materials and methodsBetween July 2001 and November 2008, 319 SLNB under LA was performed in cases of invasive breast cancer. Axillary dissection was done in 125 cases. In total, 194 patients underwent SLNB with no lymph node invasion and without additional axillary dissection. Follow-up was monitored until May 30, 2008.ResultsWith a median follow-up period of 39.5 months, there were no patients with axillary recurrence. We recorded 6 local recurrences and 3 distant metastases.ConclusionWith an experienced team, SLNB under LA is a procedure that does not expose patients to a greater risk of axillary recurrence than SLNB carried out in the traditional manner under general anesthesia.