Oncologic Safety of Sentinel Lymph Node Biopsy Alone After Neoadjuvant Chemotherapy for Breast Cancer

Wong, Stéphanie; Basik, Mark; Florianova, Livia; Margolese, Richard G.; Dumitra, Sinziana; Muanza, Thierry; Carbonneau, Annie; Ferrario, Cristiano; Boileau, Jean François

doi:10.1245/s10434-020-09211-0

Cited by 54 publications

(31 citation statements)

References 25 publications

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“…Axillary and distant recurrence-free survival were not significantly different between the 428 and 819 patients in the SLNB and ALND groups, respectively. Wong et al [ 15 ] reviewed 244 patients with clinical T1–3cN0–2 breast cancer who underwent NAC followed by SLNB for axillary staging. Of the 159 patients with ypN0 disease who underwent SLNB alone, the risk of local recurrence did not significantly differ between the cN0/ypN0 and cN1–2/ypN0 groups.…”

Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Biopsy in Breast Cancer Patients With Pathological Complete Response in the Axillary Lymph Node After Neoadjuvant Chemotherapy

et al. 2021

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Purpose Sentinel lymph node biopsy (SLNB) alone following neoadjuvant chemotherapy (NAC) remains controversial in patients with breast cancer who are initially lymph node-positive. The present study aimed to evaluate the impact of SLNB and axillary lymph node dissection (ALND) on breast cancer recurrence and survival in patients who converted from lymph node-positive to pathological node-negative (ypN0) after NAC. Methods This single-center retrospective study included 223 patients who converted to axillary lymph node-negative status after NAC and underwent breast and axillary surgery between January 2006 and December 2015. This study compared the overall survival (OS), disease-free survival (DFS), ipsilateral axillary lymph node recurrence rates and incidence of postoperative complications, especially, arm lymphedema and shoulder stiffness between SLNB and ALND. Results This study included 223 patients with axillary pathological complete response (pCR) after NAC and surgery. The SLNB and ALND groups included 94 and 129 patients, respectively. The median follow-up time was 57 (range, 6–155) in the SLNB group and 99 (range 2–159) months in the ALND group. The corresponding 5-year OS and DFS rates were 96.3% and 94.2% ( p = 0.392), and 89.2% and 86.4% ( p = 0.671), respectively. Four patients (4.3%) in the SLNB group and nine (7.0%) in the ALND group developed locoregional recurrences. Ipsilateral axillary lymph node recurrence and distant metastasis were observed in one (1.1%) and three (2.3%) patients, and in 10 (10.6%) and 11 (8.5%) patients, respectively. Patients in the ALND group were more likely than their SLNB counterparts to experience complications, such as shoulder stiffness (9 [7.0%] vs. 4 [4.3%] patients, p = 0.57). The rate of lymphedema in the ALND group was three times that in the SLNB group (35 [27.1%] vs. 8 [8.5%] patients, p < 0.001). Conclusion As an alternative to ALND, SLNB has oncological safety in patients with axillary pathological complete response after NAC.

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Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Biopsy in Breast Cancer Patients With Pathological Complete Response in the Axillary Lymph Node After Neoadjuvant Chemotherapy

et al. 2021

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“…For a long time, the importance of the FNR was unclear, since leaving chemo-resistant cancer in the nodes may increase axillary recurrence compared to the adjuvant setting. A retrospective single-center study from Canada investigated 102 patients in this setting [ 20 ]. Of these, 71% had regional irradiation and a medium of 4 negative sentinel nodes were removed.…”

Section: Clinically Node-positive Breast Cancermentioning

confidence: 99%

“…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%

Axillary surgery in node-positive breast cancer

et al. 2022

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“…In a study conducted by Wong et al, patients with stage I-III BC who underwent NAC demonstrated acceptable short-term locoregional control associated with SLNB alone in cN1-2/ypN0 patients. SLNB was the most accurate minimally invasive method for staging the axilla and evaluating residual nodal disease [ 43 ]. Chun et al, in an analysis of 676 patients, suggested SLNB alone may be a possible option for patients with 1–3 SN+ BC after NAC without compromise of recurrence or overall survival [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Superparamagnetic Iron Oxide for Identifying Sentinel Lymph Node in Breast Cancer after Neoadjuvant Chemotherapy: Feasibility Study

Kurylcio

Pelc

Skórzewska

et al. 2021

JCM

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Sentinel lymph node biopsy (SLNB) is a well-established procedure for staging clinically node-negative early breast cancer (BC). Superparamagnetic iron oxide (SPIO) demonstrated efficacy for nodal identification using a magnetic probe after local retroaeroal interstitial injection. Its benefits lie in its flexibility, which is an essential property in the global setting, where access to the isotope is difficult. To the best of our knowledge, this is the first study to evaluate the feasibility and safety of the SPIO for SLNB in BC patients treated with neoadjuvant chemotherapy (NAC). Seventy-four female patients were included. The median time of lymph node retrieval was 20 min. The median number of resected sentinel nodes (SNs) was 4. SN was detected in all patients. No serious adverse event was observed. SPIO in identifying SN in BC patients after NAC is feasible and oncologically safe.

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Oncologic Safety of Sentinel Lymph Node Biopsy Alone After Neoadjuvant Chemotherapy for Breast Cancer

Cited by 54 publications

References 25 publications

Sentinel Lymph Node Biopsy in Breast Cancer Patients With Pathological Complete Response in the Axillary Lymph Node After Neoadjuvant Chemotherapy

Sentinel Lymph Node Biopsy in Breast Cancer Patients With Pathological Complete Response in the Axillary Lymph Node After Neoadjuvant Chemotherapy

Axillary surgery in node-positive breast cancer

Superparamagnetic Iron Oxide for Identifying Sentinel Lymph Node in Breast Cancer after Neoadjuvant Chemotherapy: Feasibility Study

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