# Role of Axillary Restaging in Breast Cancer Patients with Preoperative Diagnosis of Isolated Chest Wall Recurrence After Mastectomy: A Literature Review

## TL;DR

This paper reviews whether axillary restaging is necessary for breast cancer patients with chest wall recurrence after mastectomy.

## Contribution

The study systematically analyzes literature to clarify the role of axillary staging in managing isolated chest wall recurrence.

## Key findings

- Ipsilateral axillary recurrence was low in patients with or without axillary restaging.
- Only 14.3% of operated patients had metastatic nodes on axillary staging.
- Larger studies with longer follow-up are needed to determine optimal axilla management.

## Abstract

Background and Objectives: Chest wall recurrence can occur infrequently after mastectomy in breast cancer patients. While wide excision of chest wall recurrence is indicated in operable patients without metastasis elsewhere, management of the axilla remains controversial. We reviewed the literature to determine the role of axillary staging in patients with a preoperative diagnosis of isolated chest wall recurrence. Materials and Methods: A PubMed search was performed for relevant articles dated between 1 January 2000 and 31 December 2024. Only English articles comprising female patients with invasive chest wall recurrence after mastectomy were included. Patients with concomitant metastasis elsewhere, no operation for recurrence and no oncological outcomes were excluded. The outcomes were compared between patients with or without axillary staging during recurrence. Results: A total of 15 studies with 485 eligible patients were analyzed. Of these patients, 242 (49.9%), 182 (37.5%), 53 (10.9%), and 8 (1.6%) patients had sentinel lymph node biopsy (SLNB), no axillary surgery, failed SLNB, and upfront axillary lymph node dissection (ALND), respectively, for restaging. Among operated patients with reported axillary status, 33/231 (14.3%) had metastatic nodes on axillary staging. On follow-up of 38.2 months (range: 10–61.2), 101/485 (20.8%) patients developed a second recurrence, of which 16/447 (3.6%) developed ipsilateral axillary recurrence. Ipsilateral axillary recurrence among patients with and without axillary surgery was 12/182 (6.6%) and 4/265 (1.5%), respectively. Conclusions: Ipsilateral axillary recurrence was low in patients with or without axillary restaging on medium-term follow-up. Due to the heterogeneity of the studies, larger studies with longer follow-up periods are needed to determine the best management for the axilla.