Favorable outcome with sentinel lymph node biopsy alone after neoadjuvant chemotherapy in clinically node positive breast cancer at diagnosis: Turkish Multicentric NEOSENTI-TURK MF-18-02-study

Cabıoğlu, Neslihan; Karanlık, Hasan; Yıldırım, Nilgün; Müslümanoğlu, Mahmut; Karadeniz, Güldeniz; Can, Dan; Tükenmez, Mustafa; Ersoy, Yeliz Emine; Uras, Cihan; Zengel, Baha; Emiroglu, Selman; Polat, Ayfer Kamalı; Yenıay, Levent; Özkurt, Enver; Kara, Halil; İbiş, Kamuran; Aydıner, Adnan; Özmen, Vahit; İğci, Abdullah

doi:10.1016/j.ejso.2021.06.024

Cited by 26 publications

(8 citation statements)

References 30 publications

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“…This is probably related to our short follow-up period. In a recent national study, it was reported that ALND could be safely avoided when certain conditions were met; for example, in meticulously selected cN-positive patients who underwent SLNB after NAC having breast and/or nodal pCR, cT1-2, or low volume residual nodal disease with luminal pathology, as long as axillary radiotherapy was provided [ 14 ]. Two prospective randomized clinical trials (NSABP-B51 and ALLIANCE) are still in progress, which hope to prove the oncologic safety of the axillary approach in patients who are node-positive receiving neoadjuvant systemic therapy, and the results will play an important role in determining the treatment in this patient group [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

The Oncologic Safety of Sentinel Lymph Node Biopsy in Patients with Node-Positive Breast Cancer with Complete Response to Neoadjuvant Chemotherapy: A Single-Center Experience

et al. 2023

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Objective. To evaluate the efficiency and safety of sentinel lymph node biopsy (SLNB) in patients with breast cancer with complete response to neoadjuvant chemotherapy (NAC). Methods. Ninety-two consecutive (T1-4 and N1-2) patients with breast cancer who had pathologic and/or clinical and radiologic axillary lymph node involvement were included. All patients received NAC. Patients with a clinical and radiologic complete response in the axilla after NAC underwent SLNB. Pathologic complete response (ypCR) was defined as the absence of residual invasive and in situ cancer, and near-complete response (ypNCR) represented in situ and/or ≤ 1 mm residual tumor in the breast and/or presence of malignant cell clusters (≤0.2 mm) and/or micrometastases (≤2.0 mm) in the axillary lymph nodes (ALN) (ypTis/T1mi, ypN0i+/pN1mi). Results. The mean age of the 92 patients was 49.6 ± 10.3 years and the mean follow-up was 34.0 ± 17.8 months. With respect to breast tumors, 23 (25.0%) patients had complete and 14 (15.2%) had a near-complete response to NAC. Complete response in ALN was obtained in 39 (42.4%) patients and near-complete in six (6.5%) patients. The overall survival of the 33 patients who achieved ypCR and ypNCR was 100% and the remaining 59 patients with partial or no response to NAC was 83.1% at a mean follow-up of 34 months ( p = 0.063 ). Conclusions. In this study, no event developed in cases with ypCR and ypNCR in the breast and axilla. The persistence of the same results in long-termfollow-ups may enable the use of ypNCR as a positive prognostic marker in addition to ypCR.

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Section: Discussionmentioning

confidence: 99%

The Oncologic Safety of Sentinel Lymph Node Biopsy in Patients with Node-Positive Breast Cancer with Complete Response to Neoadjuvant Chemotherapy: A Single-Center Experience

et al. 2023

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“…After excluding these 7 studies, 15 studies with 1,515 eligible patients (range, 29-242 patients) (10,11,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) were analysed in this review (Table 2). All studies were retrospective in nature except for a study which was prospective (26).…”

Section: Resultsmentioning

confidence: 99%

Oncologic outcomes in breast cancer patients with metastatic nodes and pathological nodal response following neoadjuvant chemotherapy without axillary dissection: a literature review

Lim¹,

Leong²

2023

Ann Transl Med

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Background and Objective With promising nodal pathological complete response (pCR) after neoadjuvant chemotherapy, the role of axillary lymph node dissection (ALND) was questioned. While there is much data on the accuracy of axillary staging after neoadjuvant chemotherapy to predict nodal pCR, limited data on the oncological safety of omitting ALND exists. We aim to review the oncological safety of omitting ALND in patients with initially metastatic nodes achieving nodal pCR, based on axillary staging, following neoadjuvant chemotherapy. Methods A PubMed search of relevant articles from 1 st January 2013 to 15 th September 2022 was performed. Studies with duplication of patients, ALND only, no oncological details, initially N0 patients only and patients without nodal pCR were excluded. Key Content and Findings Fifteen studies with 1,515 eligible patients (range, 29–242 patients) were analysed. There was heterogeneity of patients among the included studies and patients had varying TN staging, making selection criteria for omission of ALND inconclusive. Sentinel lymph node biopsy (SLNB) was the most studied mode of axillary staging in 1,416 (93.5%) patients, though 35.7% had <3 SLN harvested. On average median follow-up of 52.8 months (range, 9–110 months), axillary recurrence ranged from 0% to 3.4%. There was limited data on survival outcomes. Conclusions In node positive breast cancer patients who achieved nodal pCR after neoadjuvant chemotherapy, the axillary recurrence rate was low without ALND. However, survival data was limited. The selection criteria and ideal axillary staging technique for patients, who are suitable for axillary preservation, are unclear. More prospective studies with longer follow-up, providing survival data, are needed.

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“…As a first de-escalation step, some studies analysed whether it was safe to replace ALND with ART in case of ypN0 (SARP). In the prospective cohort study NEOSENTI-TURK MF-18-02 [ 57 ], 211 patients with cN+, ypN0 (SLNB) were treated with RNI (axilla level 1–4) instead of ALND. Only one patient developed a nodal recurrence 60 months after treatment.…”

Section: De-escalation Of Axillary Treatmentmentioning

confidence: 99%

Regional radiotherapy after primary systemic treatment for cN+ breast cancer patients

Boersma¹,

Mjaaland²,

Duijnhoven³

2023

The Breast

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Favorable outcome with sentinel lymph node biopsy alone after neoadjuvant chemotherapy in clinically node positive breast cancer at diagnosis: Turkish Multicentric NEOSENTI-TURK MF-18-02-study

Cited by 26 publications

References 30 publications

The Oncologic Safety of Sentinel Lymph Node Biopsy in Patients with Node-Positive Breast Cancer with Complete Response to Neoadjuvant Chemotherapy: A Single-Center Experience

The Oncologic Safety of Sentinel Lymph Node Biopsy in Patients with Node-Positive Breast Cancer with Complete Response to Neoadjuvant Chemotherapy: A Single-Center Experience

Oncologic outcomes in breast cancer patients with metastatic nodes and pathological nodal response following neoadjuvant chemotherapy without axillary dissection: a literature review

Regional radiotherapy after primary systemic treatment for cN+ breast cancer patients

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