Intraoperative Assessment of Sentinel Lymph Nodes After Neoadjuvant Chemotherapy in Patients with Breast Cancer

Rubio, Isabel T.; Aznar, F.; Lirola, J.L.; Peg, Vicente; Xercavins, Jordi

doi:10.1245/s10434-009-0695-y

Cited by 35 publications

(21 citation statements)

References 20 publications

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“…[29][30][31] Although there was a concern that NAC-induced histological changes of metastases and lymph nodes such as fi brosis, fat necrosis, histiocytic accumulation, and granulation tissue formation may interfere with the detection of metastases, our results were comparable with those obtained in early untreated breast cancer. We compared the results of intraoperative frozen-section (FS) analysis in patients treated with NAC and those not treated with NAC.…”

Section: Intraoperative Assessment Of Sentinel Lymph Nodes After Neoasupporting

confidence: 76%

“…Similarly, Rubio et al demonstrated that the sensitivity of FS in an NAC group ranged from 78.5% for micrometastases and isolated tumor cells to 100% for macrometastasis, which were not significantly different from those results obtained in a non-NAC group. 30 Both studies concluded that intraoperative FS analysis of SLN is as accurate for NAC-treated patients as for non-NAC-treated patients and is a clinically acceptable method for detecting SLN metastases to avoid a second operation in the neoadjuvant setting.…”

Section: Intraoperative Assessment Of Sentinel Lymph Nodes After Neoamentioning

confidence: 99%

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Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

Shimazu

Noguchi

2011

Surg Today

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Axillary lymph node status is the most important prognostic factor in the treatment of breast cancer. In recent years, sentinel lymph node biopsy (SLNB) has replaced conventional axillary lymph node dissection for predicting axillary lymph node status with higher accuracy. Moreover, neoadjuvant chemotherapy (NAC) is being used increasingly to treat not only patients with locally advanced inoperative breast cancer, but also those with initially operable breast cancer. The application of SLNB has now expanded to include this patient population, who were not previously considered good candidates for SLNB. A number of recent studies have evaluated the feasibility and accuracy of SLNB after NAC in breast cancer patients. Moreover, SLNB has been shown to be accurate in patients scheduled to receive NAC, and repeat SLNB has been performed after NAC for patients with positive nodes detected by the initial SLNB before NAC. Thus, the optimal timing of SLNB for patients with breast cancer in the neoadjuvant setting remains controversial. This article reviews the issues surrounding SLNB before vs. after NAC, according to the published literature and our experience.

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Section: Intraoperative Assessment Of Sentinel Lymph Nodes After Neoasupporting

confidence: 76%

Section: Intraoperative Assessment Of Sentinel Lymph Nodes After Neoamentioning

confidence: 99%

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

Shimazu

Noguchi

2011

Surg Today

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“…The presence of micrometastasis or ITC in the sentinel lymph node after NAT should be considered as a positive finding making ALND mandatory [49,67]. Posttreatment changes in the removed lymph nodes may be identified if previously positive lymph nodes are removed and assessed.…”

Section: Surgical Lymph Node Stagingmentioning

confidence: 99%

Surgical Management of Breast Cancer Treated with Neoadjuvant Therapy

2018

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“…When faced with those cases, pathologists may want to consider using frozen sections in addition to TPs to reduce the high false-negative rate associated with the use of TP alone. 20 Knowledge of the grade and histopathologic subtype of the carcinoma before the initiation of therapy could also be helpful. Good communication between pathologists and surgeons is, as always, key.…”

Section: Commentmentioning

confidence: 99%

Touch Preparations for the Intraoperative Evaluation of Sentinel Lymph Nodes After Neoadjuvant Therapy Have High False-Negative Rates in Patients With Breast Cancer

Elliott

Shenk

Thompson

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.-The use of a touch preparation for intraoperative sentinel lymph node diagnosis has become a preferred method of many pathologists because of its reported high sensitivity and rapid turnaround time. However, after neoadjuvant chemotherapy many lymph nodes have significant treatment-related changes that may affect the diagnostic accuracy of the intraoperative evaluation.Objective.-To determine the accuracy of touch preparation for the intraoperative diagnosis of metastatic breast carcinoma in the neoadjuvant setting.Design.-We reviewed retrospectively the results of intraoperative evaluations for 148 different sentinel lymph nodes from 63 patients who had undergone neoadjuvant chemotherapy for invasive breast cancer at our institution. The intraoperative touch preparation results were compared with the final pathology reports in conjunction with relevant clinical data.Results.-Use of touch preparation for the evaluation of sentinel lymph nodes intraoperatively after neoadjuvant therapy was associated with a low sensitivity of 38.6% (95% confidence interval [CI], 24.4-54.5) but high specificity of 100% (95% CI, 96.5-100). There was no difference in sensitivity rates between cytopathologists and noncytopathologists in this cohort (P ¼ .40). Patients with invasive lobular carcinoma and those who had a clinically positive axilla before the initiation of neoadjuvant therapy were the most likely to have a false-negative result at surgery.Conclusions.-Intraoperative touch preparations should not be used alone for the evaluation of sentinel lymph nodes in the setting of neoadjuvant therapy for breast cancer because of low overall sensitivity.

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Intraoperative Assessment of Sentinel Lymph Nodes After Neoadjuvant Chemotherapy in Patients with Breast Cancer

Cited by 35 publications

References 20 publications

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

Surgical Management of Breast Cancer Treated with Neoadjuvant Therapy

Touch Preparations for the Intraoperative Evaluation of Sentinel Lymph Nodes After Neoadjuvant Therapy Have High False-Negative Rates in Patients With Breast Cancer

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