Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer

Julian, Thomas B.; Patel, Nilesh A.; Dusi, Deborah; Olson, Peter; Nathan, Girija; Jasnosz, Katherine M.; Isaacs, Gilbert; Wolmark, Norman

doi:10.1016/s0002-9610(01)00736-x

Cited by 89 publications

(44 citation statements)

References 17 publications

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“…Unlike previously reported studies of lymphatic mapping and SLN biopsy, [1][2][3][4][5][6][7][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] the patients in the current study all had cytologically documented positive lymph nodes at the time of initial presentation. Although SLN identification technically was feasible, the false-negative rate of 25% reported here is much higher than that reported for other series on lymphatic mapping in breast cancer.…”

Section: Discussionmentioning

confidence: 62%

“…Nevertheless, published retrospective reviews of singleinstitution experiences and multicenter series and a recent meta-analysis have shown that SLN identification rates and false-negative rates after preoperative chemotherapy are comparable to the rates reported in patients who did not receive preoperative chemotherapy. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Preoperative chemotherapy with anthracycline, cyclophosphamide, and taxane-containing regimens has been shown to sterilize involved axillary lymph nodes in approximately 35% to 40% of patients. 15,16,34 Newer regimens in combination with novel biologics likely will increase the conversion rate even further.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The SLN identification rate was significantly lower in patients who had skin involvement at the time of initial presentation. We observed no significant differences in the SLN identification rate according to age, body mass index, clinical tumor size, tumor location, lymphatic mapping method used, or surgeon experience.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 To date, 16 single-institution or multicenter, retrospective studies have been published that examined the feasibility and accuracy of SLN biopsy after preoperative chemotherapy. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] SLN identification rates range from 84% to 98%, and reported false-negative rates range from 0% to 20%. The overall accuracy of SLN biopsy after preoperative chemotherapy for breast cancer ranges from 88% to 100%.…”

Section: Methods Between 1994 and 2002 69 Patients Who Had Axillarymentioning

confidence: 99%

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

Shen

Gilcrease

Babiera

et al. 2007

Cancer

156

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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.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methods Between 1994 and 2002 69 Patients Who Had Axillarymentioning

confidence: 99%

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

Shen

Gilcrease

Babiera

et al. 2007

Cancer

156

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“…Single-institution studies of SLNB after neoadjuvant chemotherapy have shown variable success rates of SLN identification in the range of 84%-94% and FNRs in the range of 0%-33% [72][73][74][75][76][77][78]. The effect of a learning curve becomes apparent, with the newer studies reporting lower FNRs.…”

Section: Challenges Of Surgical Approach After Pstmentioning

confidence: 99%

Primary Systemic Therapy of Breast Cancer

et al. 2006

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Primary systemic therapy (PST) or neoadjuvant therapy is used in nonmetastatic breast cancer to treat systemic disease earlier, decrease tumor bulk ideally to a complete pathological response (pCR), and reduce the extent of surgery. The multitude of clinical trials using PST in breast cancer patients has not proven the fundamental hypotheses of improved overall survival and disease-free survival that drove the investigation of PST. The other potential advantages of PST, which include increasing the rate of breast-conserving surgery and predicting outcome to a particular chemotherapy regimen, are also not conclusively established. We examined the published literature on PST for breast cancer and predominantly focused our review on data from large, randomized clinical trials comparing primary systemic chemotherapy with adjuvant chemotherapy, different primary systemic chemotherapy regimens, primary systemic chemotherapy with hormonal therapy, and different preoperative hormonal therapies. Although the optimal neoadjuvant chemotherapy regimen has not been established, a combination of four cycles of an anthracycline followed by four cycles of a taxane appears to produce the highest pCR rate (22%-31%). In patients with HER-2-positive breast cancer, concurrent use of neoadjuvant trastuzumab with an anthracycline-taxane combination has produced provocative results that require further confirmatory studies. Preoperative hormonal therapy is associated with low pCR rates and should be reserved for patients who are poor candidates for systemic chemotherapy. The optimal management of patients with residual disease after the administration of maximum neoadjuvant therapy remains to be defined. The surgical approach, including the role of sentinel node biopsy and delivery of radiation therapy after PST in breast cancer patients, is evolving. Ongoing clinical trials will help identify the subset of patients who would most benefit from the use of PST, establish the most effective PST regimen, and determine the optimal multidisciplinary approach in the management of breast cancer. The Oncologist 2006;11:574-589 Learning ObjectivesAfter completing this course, the reader will be able to:1. Describe the rationale for using primary systemic therapy (PST) in the treatment of nonmetastatic breast cancer.2. Discuss the pathologic complete response (pCR) rate as a surrogate marker of PST benefit.3. Select the most appropriate regimen for a patient with breast cancer considered for PST.4. Explain the role of sentinel node biopsy and delivery of radiation therapy after PST in breast cancer patients.Access and take the CME test online and receive 1 AMA PRA category 1 credit at CME.TheOncologist.com CME CME This material is protected by U.S.

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