Sentinel lymph node biopsy after neo-adjuvant chemotherapy in patients with breast cancer: Are the current false negative rates acceptable?

Abstract

The advent of sentinel lymph node biopsy has revolutionised surgical management of axillary nodal disease in patients with breast cancer. Patients undergoing neo-adjuvant chemotherapy for large breast primary tumours may experience complete pathological response on a previously positive sentinel node whilst not eliminating the tumour from the other lymph nodes. Results from 2 large prospective cohort studies investigating sentinel lymph node biopsy after neo-adjuvant chemotherapy demonstrate a combined false negative rate of 12.6-14.2% and identification rate of 80-89% with the minimal acceptable false negative rate and identification rate being set at 10% and 90%, respectively. A false negative rate of 14% would have been classified as unacceptable when compared to the figures obtained by the pioneers of sentinel lymph node biopsy which was 5% or less.

Sentinel node detection in muscle-invasive urothelial bladder cancer is feasible after neoadjuvant chemotherapy in all pT stages, a prospective multicenter report

“…SNd in postresection scars has also been feasible in penile cancer after previous removal of primary tumor [17]. The effect of NAC on SN biopsies was studied thoroughly in breast cancer showing increase in FNR [18]. However, the parallel to MIBC is not fully compatible; the use of NAC in breast cancer has increased the use of SNd on larger high-risk tumors.…”

Advances in sentinel node dissection in prostate cancer from a technical perspective

“…57 In melanoma patients, a FN rate of 11% was noted, 58 and higher rates were described in patients treated with neoadjuvant chemotherapy for breast cancer. 59 The FN rate, however, could be reduced by implementing immunohistochemistry. 60 In PCa the rate of FN SN in a review of the literature was approximately 2%, but varied widely among case series (0-23%).…”

Sentinel lymph node assessment in breast cancer patients receiving neo‐adjuvant chemotherapy: to biopsy before or after?

“…Most contemporary studies on sentinel node biopsy in early stage breast cancer report sentinel node identification rates above 95%, nearing 100%; whereas the false‐negative rate is also approximately 7.5% . While a low sentinel node identification rate and a high false‐negative rate are common in the early part of learning curve, most centres performing post‐NAC sentinel node biopsy are well past their learning curve. Additionally, indirect comparison of different arms in SENTINA trial shows that surgeons with a 99.1% sentinel node identification rate for pre‐NAC sentinel node biopsy had a much lower sentinel node identification rate for post‐NAC sentinel node biopsy.…”