Sentinel lymph node BIOPSY after neoadjuvant therapy in breast cancer patients with lymph node involvement at diagnosis. Could wire localization of clipped node improve our results?

Iranzo, Marina Alarcón; Buch, Elvira; Julve, Ana; Hernandorena, Marta; Tajahuerce, Marcos; Rodríguez, Héctor Hernández; Bermejo, Begoña; Ramírez, Joaquín Gómez; Burgués, Octavio; Díaz, Sandra; Alcalá, Gara M.

doi:10.1016/j.surge.2021.01.013

Cited by 9 publications

(3 citation statements)

References 19 publications

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“…Besides, it is reported that in the real world, the FNR of marking and removing a previously positive axillary lymph node for breast cancer after NAC ranges from 0% to 28.6%. [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] So this clippedmarked method may not decrease FNR in all populations. However, we found differences in the SLN FNR between those cases when the clip was identi ed in the SLN versus those cases with the clip identi ed in the ALND specimen, and this difference may be clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

Improved false-negative rates using a novel patient selection flowchart in initially biopsy-proven node-positive breast cancer undergoing blue-dye alone guided sentinel lymph node biopsy after neoadjuvant chemotherapy

Chen

Huang

et al. 2022

Breast Cancer Res Treat

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Purpose: Current trials support the application of sentinel lymph node biopsy (SLNB) in node-positive breast cancer treated with neoadjuvant chemotherapy (NAC) with a lower false negative rate (FNR) if dual-tracer (radioisotope and blue-dye) is used. However, radioisotopes are not available in many areas of the world. In this study, we evaluated the feasibility and accuracy of SLNB mapped with methylene-bluedye alone.Methods: This study enrolled 132 patients with biopsy-proven node-positive breast cancer with a clip placed in the positive node who then received NAC. After chemotherapy and before operation, all patients underwent axillary ultrasound (AUS) assessment and were classi ed as either negative (AUS-) or positive (AUS+) according to the axillary status. All patients underwent both SLNB and axillary lymph node dissection (ALND). SLNB was mapped with methylene-blue-dye alone. FNRs were evaluated on factors potentially affecting false-negative SLN nding.Results: Using methylene-blue-dye alone, the FNR of SLNB was 9.9%. Post-NAC AUS assessment (p=0.009), number of SLNs retrieved (p=0.029), and the retrieved of the clipped node (p=0.086), showed association with FNRs in multivariate analysis. In AUS-group, FNR was as low as 2.5%. In AUS+ group, retrieving ≥4 SLNs including the clipped node improved FNR from 17.1% to 4.8%. A owchart was designed with the combination of post-NAC AUS assessment, retrieved SLN number, and the retrieved of clipped node further improve overall FNR to 3.3%. Conclusion:In biopsy-proven node-positive breast cancer treated with NAC, using a owchart to optimize patient selection reduces the FNR of single-tracer (methylene-blue-dye) guided SLNB.

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Section: Discussionmentioning

confidence: 99%

Improved false-negative rates using a novel patient selection flowchart in initially biopsy-proven node-positive breast cancer undergoing blue-dye alone guided sentinel lymph node biopsy after neoadjuvant chemotherapy

Chen

Huang

et al. 2022

Breast Cancer Res Treat

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“…Alarcon et al assessed the efficacy and accuracy of the clipped node’s wire localization to reduce the false-negative rate of SN retrieval. For intraoperative localization, wire marking has proven to be a safe procedure in which removal of SN was achieved in all patients [ 42 ]. Similarly, the detection rate of SPIO-guided SLNB in our study was 100%, resulting in 0% FNR.…”

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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“…More recently, Alarcón and colleagues performed SLNB and removal of clipped positive node after NAC using ultrasound guided wire hook placement 30 minutes prior to the definitive surgery in 28 of 103 patients, and found the IR of the clipped node to be 100% with FNR of 0% with no migration or complications. The authors concluded that wire placement immediately prior to surgery and an accurate surgical technique during the nodal excision minimize the risk of wire potential displacement [29].…”

Section: Wire Localizationmentioning

confidence: 99%

Options to Determine Pathological Response of Axillary Lymph Node Metastasis after Neoadjuvant Chemotherapy in Advanced Breast Cancer

Murthy

Young

Tokumaru

et al. 2021

Cancers

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Increasing use of neoadjuvant therapy in large tumors or node positive disease in breast cancer patients or hormone negative and HER 2 overexpressing cancers often gives rise to complete clinical response, with resolution of disease in the breast and axilla. These results have raised important questions to deescalate loco-regional surgical treatment options with minimum recurrence risk and treatment related morbidity. Although there is excellent prognosis following clinical response, the primary goal of surgery still remains to confirm complete pathological response in the biopsied node that was previously positive and now clinically/radiologically negative (ycN0). Biopsied lymph nodes are often marked with a clip to allow future identification at the time of definitive surgery. The goal of lymph node surgery in oncology is that it should be accurate, hence the significance of localizing the biopsied node. This article aims to review the different options to localize the deemed positive node at the time of definitive surgery, in order to help determine pathological response after neoadjuvant therapy.

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Sentinel lymph node BIOPSY after neoadjuvant therapy in breast cancer patients with lymph node involvement at diagnosis. Could wire localization of clipped node improve our results?

Cited by 9 publications

References 19 publications

Improved false-negative rates using a novel patient selection flowchart in initially biopsy-proven node-positive breast cancer undergoing blue-dye alone guided sentinel lymph node biopsy after neoadjuvant chemotherapy

Improved false-negative rates using a novel patient selection flowchart in initially biopsy-proven node-positive breast cancer undergoing blue-dye alone guided sentinel lymph node biopsy after neoadjuvant chemotherapy

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

Options to Determine Pathological Response of Axillary Lymph Node Metastasis after Neoadjuvant Chemotherapy in Advanced Breast Cancer

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