Sentinel Lymph Node Biopsy in Breast Cancer Patients Undergoing Neo-Adjuvant Chemotherapy: Clinical Experience with Node-Negative and Node-Positive Disease Prior to Systemic Therapy

Abstract

Background: Sentinel lymph node biopsy (SLNB) has emerged as the standard procedure to replace axillary lymph node dissection (ALND) in breast cancer (BC) patients undergoing neo-adjuvant chemotherapy (NAC). SLNB is accepted in clinically node-negative (cN0) patients; however, its role in clinically node-positive (cN+) patients is debatable. Methods: We performed a retrospective analysis of BC patients undergoing NAC and SLNB. Our aim was to evaluate the clinical significance of SLNB in the setting of NAC. This was accomplished by comparing the characteristics and oncological outcomes between cN0 and cN+ patients prior to NAC and type of axillary surgery. Results: A total of 291 patients were included in the analysis: 131 were cN0 and 160 were cN+ who became ycN0 after NAC. At a median follow-up of 43 months, axillary recurrence occurred in three cN0 (2.3%) and two cN+ (1.3%) patients. However, there were no statistically significant differences in oncological outcomes (disease-free survival, distant disease-free survival, overall survival, and breast-cancer-specific survival) between cN0 and cN+ patients nor between patients treated with SLNB only or ALND. Conclusions: SLNB in the setting of NAC is an acceptable procedure with a general good prognosis and low axillary failure rates for both cN0 and cN+ patients.

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

“…In this setting, SLNB proved to be an acceptable procedure because of a good prognosis and low axillary failure rates in both groups of patients. No significant differences in oncological outcomes were found in the case of both axillary involvement or non-involvement after NACT, neither in the SLNB alone nor in the SLNB + ALND group [5].…”

“…Sentinel lymph node (i.e., the first lymph nodes in which cancer cells appear, which are most likely to spread from the primary neoplasm) biopsy (SLNB) is a minimally invasive procedure that has largely replaced axillary lymph node dissection (ALND) in early breast cancer (BC) surgery, especially in the case of no axillary lymph node involvement (cN0) and in patients at stage T1-2 cN0 early BC with one to two positive sentinel lymph nodes (SLNs). The advantages of this technique are its minimally invasive approach to the axilla and the possibility of avoiding the complications of ALND [1][2][3][4][5].…”

“…In order to minimize the SLNB FNR in patients with axillary involvement, different techniques and strategies have been proposed (e.g., TAD by marking biopsy-positive lymph nodes prior to NACT with various tools such as carbon suspension, metallic clip, radioactive or magnetic seeds, radar reflectors, and radiofrequency markers, the use of a dual tracer, or the removal of at least three lymph nodes) [41][42][43][44][45]. To date, the prognostic significance of these strategies has not been sufficiently investigated, but some studies have demonstrated, and confirmed with follow-up data, that the SLNB is neither related with an increased recurrence rate in axilla, nor with a worsened disease-free survival (DFS) or OS [5,[46][47][48][49][50].…”

Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Axillary Conversion after Neoadjuvant Chemotherapy—A Single-Tertiary Centre Experience and Review of the Literature

“…Considering the treatment response in patients who received NAC, several studies indicated that positive lymph node axilla can be converted to pathologically negative status with the use of NAC in about 32–74% of patients [ 9 , 19 , 30 , 42 , 51 , 57 ]. Newman et al [ 31 ] described a ycN0 conversion rate of 32%, while Dominici et al [ 58 ] reported a pathologic complete response rate of 74%, observed in the 109 women included in their study.…”

De-Escalation Surgery in cT3-4 Breast Cancer Patients after Neoadjuvant Therapy: Predictors of Breast Conservation and Comparison of Long-Term Oncological Outcomes with Mastectomy

“…The response to NAT also holds prognostic significance, being closely linked to long-term oncological outcomes [ 4 , 6 , 7 , 8 , 9 ]. Furthermore, successful tumor reduction through NAT can minimize the extent of surgery required, eliminating the need for unnecessary axillary lymph node dissection (ALND) [ 10 , 11 ] and making breast-conserving surgery (BCS) possible for patients initially considered for mastectomy [ 12 , 13 , 14 , 15 ]. In the upfront surgical setting, BCS has been proven to be a safe alternative to mastectomy in terms of overall survival (OS) [ 16 , 17 ], with recent studies even suggesting superior survival rates associated with BCS [ 18 , 19 ].…”