Sentinel Lymph Node Biopsy Is Accurate After Neoadjuvant Chemotherapy for Breast Cancer

Breslin, Tara M.; Cohen, Lisa F.; Şahin, Ayşegül; Fleming, Jason B.; Kuerer, Henry Mark; Newman, Lisa A.; Delpassand, Ebrahim S.; House, Rosalyan; Ames, Frederick C.; Feig, Barry W.; Ross, Merrick I.; Singletary, S. Eva; Buzdar, Aman U.; Hortobágyi, Gabriel N.; Hunt, Kelly K.

doi:10.1200/jco.2000.18.20.3480

Cited by 261 publications

(110 citation statements)

References 24 publications

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“…There has been concern voiced by some investigators that neoadjuvant chemotherapy may alter the anatomy of the lymphatics, rendering the sentinel lymph node biopsy an inadequate representation of disease in the axilla after neoadjuvant treatment [51]. This concern was initially amplified by studies demonstrating low sentinel node identification rates and high falsenegative rates [52][53][54][55]. These findings may have been attributed to the inclusion of patients in these studies with inflammatory tumors and clinically positive axillary lymph node metastases.…”

Section: Timing Of Sentinel Lymph Node Biopsymentioning

confidence: 91%

Neoadjuvant therapy for breast cancer

Liu¹,

Melstrom²,

Yao³

et al. 2010

Journal of Surgical Oncology

131

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The past few decades have seen an increase in both the role and the complexity of neoadjuvant therapy for breast cancer. Neoadjuvant therapy was initially described as systemic chemotherapy for inflammatory or locally advanced breast cancer but now entails a combination of chemotherapy, endocrine therapy, and targeted therapy. Neoadjuvant systemic therapy is employed for inoperable inflammatory and locally advanced breast cancer, and also for patients with operable breast cancers who desire breast-conserving therapy (BCT) but are not candidates based on the initial size of the tumor in relation to the size of the breast. Neoadjuvant therapy in this subset of patients may impact the surgical options. This review will summarize the benefits of neoadjuvant systemic therapy and implications for BCT, the timing of sentinel node biopsy, and the utility of magnetic resonance imaging (MRI) to predict response to therapy.

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Section: Timing Of Sentinel Lymph Node Biopsymentioning

confidence: 91%

Neoadjuvant therapy for breast cancer

Liu¹,

Melstrom²,

Yao³

et al. 2010

Journal of Surgical Oncology

131

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“…These studies have demonstrated mixed results, with false-negative rates ranging from 0% to 33%, and the effects of a significant learning curve can be seen. [10][11][12][13][14][15] Many clinicians remain dissatisfied with the available data on the accuracy of post-neoadjuvant CTX SLN biopsy and have opted instead for a staging SLN biopsy performed before delivery of the neoadjuvant CTX. The primary disadvantages to this approach, however, are the requirement for an additional surgical procedure at the time of presentation and the fact that the patients identified as being node positive by this pre-CTX SLN biopsy are then committed to undergoing the completion ALND, thereby negating some of the benefits of CTX downstaging.…”

mentioning

confidence: 99%

Comprehensive Axillary Evaluation in Neoadjuvant Chemotherapy Patients With Ultrasonography and Sentinel Lymph Node Biopsy

et al. 2005

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Background: There is ongoing debate regarding the optimal sequence of sentinel lymph node (SLN) biopsy and neoadjuvant chemotherapy (CTX) for breast cancer. We report the accuracy of comprehensive pre-neoadjuvant CTX and post-neoadjuvant CTX axillary staging via ultrasound imaging, fine-needle aspiration (FNA) biopsy, and SLN biopsy. Results: Axillary staging was pathologically negative by pre-neoadjuvant CTX SLN biopsy in 53 cases (58%); these patients had no further axillary surgery. In 38 cases (42%), axillary metastases were confirmed at presentation by either ultrasound-guided FNA or SLN biopsy. These 38 patients underwent completion axillary lymph node dissection (ALND) after delivery of neoadjuvant CTX. Follow-up lymphatic mapping was attempted in 33 of these cases, and the SLN was identified in 32 (identification rate, 97%). One third of these cases were completely node negative on ALND. Residual metastatic disease was identified in 22 cases, and the SLN was falsely negative in 1 (4.5%).Conclusions: Patients receiving neoadjuvant CTX can have accurate axillary nodal staging by ultrasound-guided FNA or SLN biopsy. In cases of documented axillary metastasis at presentation, repeat axillary staging with SLN biopsy can document the post-neoadjuvant CTX nodal status. This strategy optimizes pre-neoadjuvant CTX and post-neoadjuvant CTX staging information by distinguishing the patients who are node negative at presentation from those who have been downstaged to node negativity and offers the potential for avoiding unnecessary ALNDs in both of these patient subsets.

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“…When patients submitted to neoadjuvant chemotherapy followed by BSL are studied, identification rate may be lower due to chemotherapy effects. Breslin et al study 18 found an identification rate of 84%. Other studies showed identification rates varying from 85% to 98% (as quoted by Xing et al study 19 ).…”

Section: Resultsmentioning

confidence: 99%

Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer

Aguiar

Aquino

Alves

et al. 2017

Rev. Col. Bras. Cir.

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Objective: to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99) in patients with locally advanced breast cancer. Methods: clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. Results: identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15), and, compared to Tc99 identification, the agreement rate was 94.4%. Conclusion: autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.

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Sentinel Lymph Node Biopsy Is Accurate After Neoadjuvant Chemotherapy for Breast Cancer

Cited by 261 publications

References 24 publications

Neoadjuvant therapy for breast cancer

Neoadjuvant therapy for breast cancer

Comprehensive Axillary Evaluation in Neoadjuvant Chemotherapy Patients With Ultrasonography and Sentinel Lymph Node Biopsy

Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer

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