Feasibility and Accuracy of Sentinel Lymph Node Biopsy After Preoperative Chemotherapy in Breast Cancer Patients With Documented Axillary Metastases

Abstract

BACKGROUND.The feasibility and accuracy of sentinel lymph node (SLN) biopsy in patients with breast cancer after preoperative chemotherapy has been demonstrated in a number of large, single‐institution studies. However, a relative contraindication to SLN biopsy after preoperative chemotherapy is the presence of axillary metastases at initial diagnosis. The objective of this study was to determine the feasibility and accuracy of SLN biopsy after preoperative chemotherapy in patients with documented axillary metastases at presentation.METHODS.Between 1994 and 2002, 69 patients who had axillary metastases identified by ultrasound‐guided, fine‐needle aspiration underwent SLN biopsy after treatment on prospective, preoperative chemotherapy protocols. All but 8 patients underwent axillary lymph node dissection (ALND). Those 8 patients either declined additional surgery or were offered enrollment in other institutional protocols.RESULTS.The median patient age was 49 years, and the median primary tumor size was 4 cm. The SLN identification rate was 92.8%. Thirty‐one of 64 patients (48.4%) had successfully mapped, positive SLNs. Sixty‐one patients underwent ALND, including 5 patients who did not have an SLN identified. In the 56 patients in whom a SLN was identified and an ALND was performed, 10 patients had a false‐negative SLN (25%).CONCLUSIONS.SLN biopsy was feasible after preoperative chemotherapy, even in patients who initially presented with cytologically proven, lymph node‐positive disease. However, the false‐negative rate of SLN biopsy in this group of patients was much higher than that observed in clinically lymph node‐negative patients. Based on the current results, the status of the SLN cannot be used as a reliable indicator of the presence or absence of residual disease in the axilla in this patient population. Cancer 2007. © 2007 American Cancer Society.

Primary Systemic Therapy of Breast Cancer

“…Clinically N1 patients had an SLN identification rate of 91% and an FNR of 9%, versus 97% and 0%, respectively, in N0 patients [80]. In another study, by Shen et al [81], SLNB following PST in patients with cytologically documented node-positive disease at presentation had a good identification rate (93%) but appeared to have a very high FNR (26%). In conclusion, SLNB following neoadjuvant chemotherapy is not an appropriate method for evaluating the axilla in patients with clinically or cytologically positive axillary lymph nodes at presentation.…”

Sentinel lymph node biopsy in patients with locally advanced breast cancer after neoadjuvant chemotherapy

“…There was no difference in identification of sentinel lymph node according to age. Studies by Shen et al 7 and Kinoshita et al 8 included average age of 49 and 51.1 years respectively.…”

Accuracy of sentinel lymph node biopsy after neo-adjuvant chemotherapy in patients with locally advanced breast cancer and clinically positive axillary nodes

“…The two main parameters to evaluate SLNB feasibility and accuracy in the context of NAC are the rate of successful SLN identification and the rate of false negative SLN. Regarding locally advanced breast cancer patients, these two criteria have been addressed mostly by small, single-institution studies that reported quite variable values ranging from 86.5%, to 98.0% for SIR and from 0% up to 25.0% for FNR [24][25][26][27]. This variability may be due to the limited number of patients evaluated and to their heterogeneity in terms of tumor size (T1-T4) and clinical node status (N0-N2) within and between studies.…”