Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy for Advanced Breast Cancer: Results of Ganglion Sentinelle et Chimiothérapie Neoadjuvante, a French Prospective Multicentric Study

Classe, Jean‐Marc; Bordes, V.; Campion, Loı̈c; Mignotte, H.; Dravet, F.; Lévèque, Jean; Sagan, Christine; Dupré, Pierre François; Body, G.; Giard, S.

doi:10.1200/jco.2008.18.3228

Cited by 233 publications

(114 citation statements)

References 49 publications

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“…The false-negative rate of sentinel lymph node (SLN) biopsy in either the pre-or postchemotherapy setting is low. [52][53][54] Nevertheless, the possibility remains that a pathologic complete response after chemotherapy may occur in lymph node metastases previously undetected in the clinical examination. SLN excision can be considered before preoperative systemic therapy is administered, because it provides additional information to guide local and systemic treatment decisions.…”

Section: Preoperative Systemic Therapymentioning

confidence: 99%

Breast Cancer Version 3.2014

Gradishar¹,

Anderson²,

Blair³

et al. 2014

J Natl Compr Canc Netw

175

117

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Section: Preoperative Systemic Therapymentioning

confidence: 99%

Breast Cancer Version 3.2014

Gradishar¹,

Anderson²,

Blair³

et al. 2014

J Natl Compr Canc Netw

175

117

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“…A French study, "Ganglion Sentinelle et Chimiothérapie Néoadjuvante," prospectively assessed the accuracy of SNB after neoadjuvant chemotherapy (40). A sentinel node was identified in 90% of patients.…”

Section: Snb After Neoadjuvant Chemotherapymentioning

confidence: 99%

The Sentinel Node Procedure in Breast Cancer: Nuclear Medicine as the Starting Point

Hindié

Groheux²,

Brenot-Rossi³

et al. 2011

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the factors influencing the false-negative rate of SNB in breast cancer; (2) the risks associated with the use of the technique in specific situations such as large tumors, multiple ipsilateral tumors, or the setting of neoadjuvant chemotherapy; and (3) the meaning of internal mammary drainage on lymphoscintigraphy in terms of risk of occult internal mammary involvement.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNM designates each JNM continuing education article for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.For CE credit, participants can access this activity through the SNM Web site (http://www.snm.org/ce_online) through March 2012.Axillary node status is a major prognostic factor in early breast cancer. Staging with sentinel node biopsy (SNB) leads to a substantial reduction in surgical morbidity. Recent multiinstitutional studies revealed SNB false-negative rates ranging from 5.5% to 16.7%, higher than the target (,5%) set by the 2005 guidelines of the American Society of Clinical Oncology. These alarming data point to the necessity of optimization. Dual mapping with radiotracer and blue dye, combining 2 different injection sites, and routinely using lymphoscintigraphy may improve accuracy. Factors associated with decreased sensitivity, such as prior excisional biopsy or neoadjuvant chemotherapy, should be recognized. The use of SNB in situations with a high prevalence of node positivity (large tumor, multifocality) is controversial. The risk of missed disease after negative SNB ranges from 1% to 4% in patients with T1 tumor and up to 15% in patients with T3. With peritumoral injection, internal mammary drainage is seen in about 20% of cases. Patients combining internal mammary drainage with a positive axillary sentinel node have close to a 50% probability of internal mammary involvement. Lymphoscintigraphy might thus be helpful in selecting patients for whom internal mammary radiation has a high benefit-to-risk ratio.Key Words: sentinel node biopsy; breast cancer; micrometastases; lymphoscintigraphy; internal mammary node; radiation therapy; neoadjuvant chemotherapy Because imaging techniques have limited sensitivity, the axilla must be explored surgically. Traditional staging requires levels I and II axillary lymph node dissection (ALND) with 10 or more removed nodes (3). Axillary involvement is found in 10%-30% of patients with T1 (#2 cm) tumors, depending on size. This rate reaches 45% for small T2 tumors (2.1-3 cm) and 55%-70% for larger tumors (2,4). However, routine ALND carries the risk of lymphedema, sensory disturbances, and chr...

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“…In addition, the use of radionuclide for lymphatic mapping decreased the FNR to nine percent in comparison to 14% when only lymphazurin was used (p = 0.5). In the GANEA study, which prospectively evaluated SLNB followed by confirmatory AD after NAC, the investigators reported an IR of 90% and an FNR of 11.5% [28]. In this study, patients, who did not have a palpable lymph node during presentation had a higher IR in comparison to cN1 patients (94.6% vs. 81.5%, p = 0.008).…”

Section: Reviewmentioning

confidence: 64%