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Axillary Recurrence Rate After Negative Sentinel Node Biopsy in Breast Cancer: Three-Year Follow-Up of the Swedish Multicenter Cohort Study

Bergkvist, Leif MD, PhD*†; de Boniface, Jana MD, PhD*†; Jönsson, Per-Ebbe MD, PhD; Ingvar, Christian MD, PhD§; Liljegren, Göran MD, PhD¶∥; Frisell, Jan MD, PhD**on behalf of the Swedish Breast Cancer GroupSwedish Society of Breast Surgeons

doi: 10.1097/SLA.0b013e318153ff40
Original Articles

Background: Sentinel lymph node biopsy is an established staging method in early breast cancer. After a negative biopsy, most institutions will not perform a completion axillary dissection. The present study reports the current axillary recurrence (AR) rate, overall and disease-free survival in the Swedish Multicenter Cohort Study.

Methods: From 3534 patients with primary breast cancer ≤3 cm prospectively enrolled in the Swedish multicenter cohort study, 2246 with a negative sentinel node biopsy and no further axillary surgery were selected. Follow-up consisted of annual clinical examination and mammography. Twenty-six hospitals and 131 surgeons contributed to patient accrual.

Results: After a median follow-up time of 37 months (0–75), the axilla was the sole initial site of recurrence in 13 patients (13 of 2246, 0.6%). In another 7 patients, axillary relapse occurred after or concurrently with a local recurrence in the breast, and in a further 7 cases, it coincided with distant or extra-axillary lymphatic metastases. Thus, a total of 27 ARs were identified (27 of 2246, 1.2%). The overall 5-year survival was 91.6% and disease-free survival 92.1%.

Conclusions: This is the first report from a national multicenter study that covers, not only highly specialized institutions but also small community hospitals with just a few procedures per year. Despite this heterogeneous background, the results lie well within the range of AR rates published internationally (0%–3.6%). The sentinel node biopsy procedure seems to be safe in a multicenter setting. Nevertheless, long-term follow-up data should be awaited before firm conclusions are drawn.

This large multicenter cohort study reports axillary and other recurrences in 2246 sentinel node-negative breast cancer patients after a median follow-up time of 37 months.

From the *Department of Surgery and †Center for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden; ‡Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden; §Department of Surgery, University Hospital, Lund, Sweden; ¶Department of Surgery and ∥Center for Assessment of Medical Technology Örebro, University Hospital, Örebro, Sweden; and **Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.

Supported by the Swedish Cancer Foundation and the Västmanland County Research Fund against Cancer.

Reprints: Jana de Boniface, MD, PhD, Department of Surgery and Center for Clinical Research Uppsala University, Central Hospital, SE 72189 Västerås, Sweden. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.