Role of Sentinel Lymph Node Biopsy During Contralateral Prophylactic Mastectomy

Abstract

Introduction: Contralateral prophylactic mastectomy (CPM) is the removal of the opposite breast with the aim of risk reduction in cases of unilateral breast carcinoma. Routine use of sentinel lymph node biopsy (SLNB) at the time of CPM is controversial due to low occult breast cancer risk. This study aims to determine the rate of occult breast carcinoma and to evaluate whether SLNB should be performed during CPM. Methods: Ninety-four patients who underwent CPM between 2009 and 2018 were evaluated retrospectively. Occult breast carcinoma detection rate and approach to axilla were evaluated. Results: Occult invasive breast carcinoma was detected in three patients (3.2\%): two invasive ductal carcinoma and one multifocal invasive lobular carcinoma. Axillary staging was performed in second session. SLNB was performed in two patients and a micro-metastasis in one of four sentinel lymph nodes (SLN) was detected in one patient. Axillary lymph node dissection was performed in one patient in whom SLN was not detected. Conclusion: SLNB can be performed in patients with suspicious lesion in the absence of biopsy or in patients with high-risk of occult breast cancer (postmenopausal, high Gail score, lobular histology, multi-centric tumor, ipsilateral high-risk lesion)however, routine SLNB use during CPM is not recommended in patients with no risk. SLNB in second session by intradermic radioisotope injection in case of occult carcinoma can be an alternative solution to axillary staging.