Sentinel lymph node biopsy following neoadjuvant chemotherapy: an evidence-based review and recommendations for current practice

Cavalcante, Francisco Pimentel; Millen, Eduardo Camargo; Novita, Guilherme; Zerwes, Felipe Pereira; Mattar, André; Machado, Rafael Henrique Szymanski; Frasson, Antônio Luiz

doi:10.21037/cco-22-110

Cited by 7 publications

(5 citation statements)

References 56 publications

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“…Evidence-based data suggest that SLNB in the post NACT setting is considered controversial because of the increased false negative rates that have been observed [53], which is why guidelines recommend the use of the standard dual RI + BD technique in these cases [4]. Therefore, it is reasonable to hypothesize that patients in these circumstances may benefit from adding ICG to the standard dual technique.…”

Section: Icg As Slnb Tracer In the Post Nact Settingmentioning

confidence: 99%

An Updated Review on the Emerging Role of Indocyanine Green (ICG) as a Sentinel Lymph Node Tracer in Breast Cancer

Akrida,

Michalopoulos,

Lagadinou

et al. 2023

Cancers

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Sentinel lymph node biopsy (SLNB) has become the standard of care for clinically node-negative breast cancer and has recently been shown by clinical trials to be also feasible for clinically node-positive patients treated with primary systemic therapy. The dual technique using both radioisotope (RI) and blue dye (BD) as tracers for the identification of sentinel lymph nodes is considered the gold standard. However, allergic reactions to blue dye as well as logistics issues related to the use of radioactive agents, have led to research on new sentinel lymph node (SLN) tracers and to the development and introduction of novel techniques in the clinical practice. Indocyanine green (ICG) is a water-soluble dye with fluorescent properties in the near-infrared (NIR) spectrum. ICG has been shown to be safe and effective as a tracer during SLNB for breast cancer and accumulating evidence suggests that ICG is superior to BD and at least comparable to RI alone and to RI combined with BD. Thus, ICG was recently proposed as a reliable SLN tracer in some breast cancer clinical practice guidelines. Nevertheless, there is lack of consensus regarding the optimal role of ICG for SLN mapping. Specifically, it is yet to be determined whether ICG should be used in addition to BD and/or RI, or if ICG could potentially replace these long-established traditional SLN tracers. This article is an updated overview of somerecent studies that compared ICG with BD and/or RI regarding their accuracy and effectiveness during SLNB for breast cancer.

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Section: Icg As Slnb Tracer In the Post Nact Settingmentioning

confidence: 99%

An Updated Review on the Emerging Role of Indocyanine Green (ICG) as a Sentinel Lymph Node Tracer in Breast Cancer

Akrida,

Michalopoulos,

Lagadinou

et al. 2023

Cancers

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“…Commonly used NACT regimens for lung cancer include PP scheme (pemetrexed + platinum), TP scheme (paclitaxel + platinum), and GP scheme (gemcit-Am J Transl Res 2024;16 (5):2024-2033 abine + platinum) [8]. Studies have found that NACT can shrink tumors, thereby reducing the scope and difficulty of surgery, as well as decreasing postoperative complications [9,10]. Although various treatment options for patients with stage IIIa-N2 NSCLC have prolonged the survival time of the patients, the 5-year survival rate is still only about 15% [11].…”

Section: Introductionmentioning

confidence: 99%

Predictive value of pre-operative prognostic nutritional index and systemic immune-inflammation index for efficacy and survival in patients with non-small cell lung cancer undergoing neoadjuvant chemotherapy

Lan

2024

Am J Transl Res

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Objective: To explore the predictive value of preoperative prognostic nutritional index (PNI) and systemic immune inflammation index (SII) in relation to the efficacy and prognosis in patients with non-small cell lung cancer (NSCLC) undergoing neoadjuvant chemotherapy (NACT). Methods: Data of patients with stage IIIA-N2 NSCLC who received NACT in the 910 th Hospital of Chinese People's Liberation Army from January 2017 to April 2020 were retrospectively analysed. Patients undergoing NACT were divided into the pCR group (80 cases with complete remission or partial remission) and the non-pCR group (46 cases with stable disease or progressive disease) in accordance with their treatment outcome. The pathologic and clinical data of the patients were collected and analysed to identify the factors affecting efficacy of NACT for stage IIIa-N2 NSCLC, and to evaluate the predictive value of PNI and SII in determining the efficacy of NACT. The patients were followed up for 3 years to observe the overall survival, and Cox regression analysis was employed to identify the risk factors affecting patient survival. Furthermore, the effect of PNI and SII on the survival time was analysed. Results: Multivariate regression analysis showed that tumor diameter, PNI, and SII were influencing factors for poor efficacy of NACT in patients with stage IIIa-N2 NSCLC. The non-pCR group exhibited a higher mortality within 3 years, thus a lower 3-year overall survival rate than the pCR group (P<0.05). Cox regression analysis revealed that both PNI and SII were risk factors for poor prognosis in patients with stage IIIa-N2 NSCLC undergoing NACT. Further analysis found a lower 3-year survival rate in patients with low PNI and high SII than in counterparts (P<0.05). Conclusion: Tumor diameter, PNI and SII are risk factors for poor efficacy in patients with stage IIIa-N2 NSCLC undergoing NACT. Low PNI and high SII can indicate a poor prognosis in these patients.

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“…For many years, the SLNB has been performed in patients with no evidence of axillary involvement at staging who were submitted to surgery after NACT with FNRs of about 10% and acceptable SLN identification rates [21,[32][33][34][35]. Conversely, until the last decade, patients with verified axillary involvement at staging were submitted to ALND, even in cases of complete response at this level [36,37].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, prospective studies on large samples of patients have begun to change this concept, indicating an overall SLN identification rate (SNIR) ranging from 87.6 to 97.2%, but FNRs higher than the accepted 10% are indicated by previous studies [37][38][39][40].…”

Section: Introductionmentioning

confidence: 99%

The Role of Sentinel Lymph Node Biopsy in Breast Cancer Patients Who Become Clinically Node-Negative Following Neo-Adjuvant Chemotherapy: A Literature Review

Ferrarazzo,

Nieri,

Firpo

et al. 2023

Current Oncology

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Background: In clinically node-positive (cN+) breast cancer (BC) patients who become clinically node-negative (cN0) following neoadjuvant chemotherapy (NACT), sentinel lymph node biopsy (SLNB) after lymphatic mapping with lymphoscintigraphy is not widely accepted; therefore, it has become a topic of international debate. Objective: Our literature review aims to evaluate the current use of this surgical practice in a clinical setting and focuses on several studies published in the last six years which have contributed to the assessment of the feasibility and accuracy of this practice, highlighting its importance and oncological safety. We have considered the advantages and disadvantages of this technique compared to other suggested methods and strategies. We also evaluated the role of local irradiation therapy after SLNB and state-of-the-art SLN mapping in patients subjected to NACT. Methods: A comprehensive search of PubMed and Cochrane was conducted. All studies published in English from 2018 to August 2023 were evaluated. Results: Breast units are moving towards a de-escalation of axillary surgery, even in the NACT setting. The effects of these procedures on local irradiation are not very clear. Several studies have evaluated the oncological outcome of SLNB procedures. However, none of the alternative techniques proposed to lower the false negative rate (FNR) of SLNB are significant in terms of prognosis. Conclusions: Based on these results, we can state that lymphatic mapping with SLNB in cN+ BC patients who become clinically node-negative (ycN0) following NACT is a safe procedure, with a good prognosis and low axillary failure rates.

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Sentinel lymph node biopsy following neoadjuvant chemotherapy: an evidence-based review and recommendations for current practice

Cited by 7 publications

References 56 publications

An Updated Review on the Emerging Role of Indocyanine Green (ICG) as a Sentinel Lymph Node Tracer in Breast Cancer

An Updated Review on the Emerging Role of Indocyanine Green (ICG) as a Sentinel Lymph Node Tracer in Breast Cancer

Predictive value of pre-operative prognostic nutritional index and systemic immune-inflammation index for efficacy and survival in patients with non-small cell lung cancer undergoing neoadjuvant chemotherapy

The Role of Sentinel Lymph Node Biopsy in Breast Cancer Patients Who Become Clinically Node-Negative Following Neo-Adjuvant Chemotherapy: A Literature Review

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