Oncologic Outcomes of Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy for Node-Positive Breast Cancer

Piltin, Mara A.; Hoskin, Tanya L.; Day, Courtney N.; Davis, John M.; Boughey, Judy C.

doi:10.1245/s10434-020-08900-0

Cited by 79 publications

(54 citation statements)

References 16 publications

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“…Hence, the expected FNR was much higher, and yet, the vast majority of patients did not show recurrence. Similar results were confirmed in two retrospective studies from Brazil and the Mayo Clinic with removal of a median of 2 and 3 negative sentinel nodes, respectively, and very low rate of recurrence (22,23). These results confirmed that the sentinel procedure is a valid treatment option in these patients (Table 2b).…”

Section: Clinically Node-positive Breast Cancersupporting

confidence: 81%

“…De-escalating axillary surgery in clinically node-positive breast cancer undergoing NACT(13,14) SNL= sentinel lymph node; FNR= false-negative rate; NACT=neoadjuvant chemotherapy; MARI= marking the axillary positive lymph node with an iodine seed, TAD= targeted axillary dissectionTable 2bDe-escalated axillary surgery procedure in clinically node positive-breast cancer. Axillary recurrence in node-negative patients after NACT(20)(21)(22)(23) …”

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confidence: 99%

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Axillary surgery in node-positive breast cancer

et al. 2022

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Clinically Node-positive Breast Cancersupporting

confidence: 81%

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confidence: 99%

Axillary surgery in node-positive breast cancer

et al. 2022

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“…New studies have shown that N1 patients who achieve nodal pathological response after NAC and are treated with SLNB alone have excellent locoregional control, with disease-free and overall survival similar to those who receive complete axillary dissection [33][34][35][36]. In a study from the Memorial Sloan Kettering Cancer Center (MSKCC) in which 234 biopsy-proven N1 patients underwent NAC and had ≥3 negative sentinel nodes removed with no further axillary surgery, the crude 5-year rate of regional recurrence was 1/234 (0.43%) [33].…”

Section: Discussionmentioning

confidence: 99%

“…The advantage of minimally invasive techniques such as SLNB or targeted axillary surgery is that they reduce the number of lymph nodes removed and limit the surgical sequelae related to ALND (i.e., lymphedema, chronic pain, and sensitivity disorders) which negatively impact quality of life [16,[37][38][39]. Given the recent reassuring data on the oncological safety of these approaches, their use in the future is likely to continue to increase [9,34].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Nodal Pathological Complete Response in Asian Women with Stage II–III Node-Positive Breast Cancer

et al. 2021

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Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat node-positive (N+) breast cancer. Predictors of nodal pathological complete response (pCR) in Asian women are poorly described and there is variety in the management of the axilla after NAC. We evaluated predictors of nodal pCR and axillary management in a cohort of Asian N+ patients. Methods: Consecutive biopsy-proven N+ breast cancer patients treated with NAC were identified from the Shanghai Ruijin Hospital in China. Axillary lymph node dissection was performed on all patients, irrespective of the nodal response to NAC. Results: A total of 323 patients were included. Nodal pCR was achieved in 105 patients (33%), 15% of HR+/HER2– tumors, 38% of HR+/HER2+ tumors, 49% of HR–/HER2+ tumors, and 42% of HR–/HER2–tumors (p < 0.001). Factors associated with nodal pCR were (1) receptor status (HR+/HER2– [referent]: OR 3.42, 95% CI 1.43–8.16, p = 0.006 for HR+/HER2+; OR 4.19, 95% CI 1.85–9.50, p = 0.001 for HR–/HER2+; and OR 2.94, 95% CI 1.11–7.74, p = 0.029 for HR–/HER2–), (2) breast pCR (no pCR [referent]: OR 15.22, 95% CI 6.29–36.79, p < 0.001), and (3) absence of lymphovascular invasion (LVI [referent]: OR 9.04, 95% CI 2.09–39.18, p = 0.003). Conclusion: This study confirmed expected predictors of nodal pCR in Asian women and the benefit of NAC in downstaging the axilla independently of ethnicity.

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“…There is still limited data on LRR rates in patients who achieve axillary pCR post NACT. The study of Pitilin et al found 17 LRR in 602 patients after 34 months of follow up, 3 in patients that were ypN0; of interest none of the 9 patients with ITCs had a LRR (123).…”

Section: Management Of the Axillamentioning

confidence: 95%

Neoadjuvant Chemotherapy for Breast Cancer: Moving Beyond Pathological Complete Response in the Molecular Age

Provenzano

2021

ama

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This review focuses on neoadjuvant chemotherapy for breast cancer which introduces practical issues for pathologists, including predicting response, optimising specimen handling, size measurement and assessment of residual disease, and recent advances in management of the axilla. The role of neoadjuvant chemotherapy in breast cancer is increasing, and it has become standard of care for high risk Human Epidermal Growth Factor Receptor 2 positive and triple negative breast cancers. The benefits of the neoadjuvant approach extend beyond pathological complete response to tumour downstaging permitting conservative surgi- cal options in the breast and axilla, and assessment of response provides valuable prognostic information to enable escalation and de-escalation of adjuvant therapy to optimise oncological outcomes. Hence histopathologists play a vital role in patient management in the neoadjuvant setting. Optimal patient selection for neoadjuvant chemotherapy requires consideration of pre- treatment histopathological and molecular tumour characteristics. Post chemotherapy, tumour staging can be challenging, and changes in criteria for measurement of primary tumour and metastases in the 7th and 8th editions of the TNM have led to confu- sion amongst pathologists. This review offers practical guidance on specimen handling and measurement of lesion size. Mov- ing forwards more detailed information on degree of response will be required for adjuvant therapy decision making, and the Residual Cancer Burden is emerging as the preferred method for quantifying residual disease not just within clinical trials but in routine practice. Recent advances in management of the axilla are discussed, including the significance of minimal residual disease in the form of isolated tumour cells and micrometastases which portend a worse prognosis in the neoadjuvant setting.Conclusion. Neoadjuvant chemotherapy now forms part of routine breast cancer management, and detailed histopathological assessment and an understanding of the importance of molecular tumour biology is essential for clinical decision making.

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Oncologic Outcomes of Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy for Node-Positive Breast Cancer

Cited by 79 publications

References 16 publications

Axillary surgery in node-positive breast cancer

Axillary surgery in node-positive breast cancer

Predictors of Nodal Pathological Complete Response in Asian Women with Stage II–III Node-Positive Breast Cancer

Neoadjuvant Chemotherapy for Breast Cancer: Moving Beyond Pathological Complete Response in the Molecular Age

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