Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy in Patients With Node-Positive Breast Cancer

Boughey, Judy C.; Suman, Vera J.; Mittendorf, Elizabeth A.; Ahrendt, Gretchen; Wilke, Lee G.; Taback, Bret; Leitch, A. Marilyn; Kuerer, Henry Mark; Bowling, Monet W.; Flippo‐Morton, Teresa S.; Byrd, David R.; Ollila, David W.; Julian, Thomas B.; McLaughlin, Sarah A.; McCall, Linda; Symmans, W. Fraser; Le-Petross, Huong T.; Haffty, Bruce G.; Buchholz, Thomas A.; Nelson, Heidi; Hunt, Kelly K.

doi:10.1001/jama.2013.278932

Cited by 1,320 publications

(962 citation statements)

References 19 publications

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“…This will be particularly the case in patients who are receiving primary systemic therapy and who will be assessed for their response before undergoing definitive surgery. It has been shown that when this cohort of patients undergoes SNB, they have an elevated false negative rate (12%), which is potentially lowered on removal of three or more nodes (9%) [18]. If the suspicious nodes are clipped at ultrasound and removed at SNB, then the false negative rate may fall further to less than 2% [19].…”

Section: Future Perspectivementioning

confidence: 94%

How Can Nanoparticles be used in Sentinel Node Detection?

Ahmed

Peek

Douek

2017

Nanomedicine (Lond.)

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Sentinel node biopsy (SNB) is the standard of care for axillary staging in breast cancer patients with a clinically and radiologically normal axilla. The concept is based upon the exclusion of metastases in the first draining lymph node(s) from the primary tumor. The current practice utilizes a radiolabeled tracer and blue dye (combined technique) with reported sentinel node identification rates of 96.4%, and a false negative rate of 7.3% in a large meta-analysis [1]. Although successful, this technique is limited by its dependence upon radioisotopes -with their inherent strict requirements for handling, transport, disposal and close access to nuclear medicine facilities. Blue dye is also associated with prolonged skin staining and reports of anaphylaxis in 0.9% of patients [2]. These limitations have resulted in the on-going development of alternative techniques for SNB [3,4]. Magnetic technique for SNBOne of the most promising radioisotopeindependent techniques for SNB comprises an interstitial injection of superparamagnetic iron oxide (SPIO) nanoparticles, which are identified intraoperatively with a handheld magnetometer and through visual brownblack staining of nodes. The magnetic technique has now been evaluated in a number of studies and confirmed on meta-analysis to be noninferior to the radioisotope-dependent technique in breast cancer -with sentinel node identification rates of 97.1 and 96.8%, respectively [3] -and demonstrated technical benefits over other novel techniques [4]. The noninferiority of the magnetic technique has also been demonstrated in the staging of malignant melanoma [5] and has been applied to a range of solid cancers in small cohort series, which has demonstrated its feasibility in the staging of these malignancies [6][7][8]. What is still lacking is randomized controlled trial evidence, before the magnetic technique can be considered as an alternative to the standard technique. Selective axillary surgeryThe current trend within axillary management in breast cancer is toward quantification of the axillary metastatic burden. The identification of low axillary burden has been shown to allow avoidance of formal axillary node clearance, without compromising overall and disease-free survival at long-term follow-up [9]. This evidence is leading to the concept of 'selective axillary surgery', which would allow targeted excision of only metastatically involved nodes. This relies upon improved preoperative imaging combined with novel techniques to guide surgeons intraoperatively, to involved nodes. Multimodal MRI for assessing nodal involvementMagnetic nanoparticles have been used for axillary staging noninvasively with MRI and demonstrated a sensitivity and specificity for

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Section: Future Perspectivementioning

confidence: 94%

How Can Nanoparticles be used in Sentinel Node Detection?

Ahmed

Peek

Douek

2017

Nanomedicine (Lond.)

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“…Although the standard of care was to perform an AD, the growing incidence of pCR in the axillary nodes led to the hypothesis that an SLNB could be justified in those patients. The ACOSOG-Z1071 study investigated the validity of SLNB after NAC for patients who were clinically positive before treatment but became clinically negative [32]. In this study, a pCR of 41% was found in the axilla after NAC.…”

Section: Reviewmentioning

confidence: 97%

Management of the positive axilla in 2017

Avisar

Özmen

2017

Breast Cancer Res Treat

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“…The American College of Surgeons Oncology Group (ACOSOG)'s Z1071 trial and the Sentinel Neoadjuvant (SENTINA) study both reported errors in identifying the sentinel lymph node that exceeded the limit considered acceptable following chemotherapy. 32,33 It is not yet known whether slightly more false-negative findings could translate into unfavorable oncological results such as a greater incidence of recurrence of the disease and higher mortality. In those studies, the best and most acceptable results were obtained when two types of markers were used, a dye in association with radioactive technetium, and when more than two lymph nodes were removed.…”

Section: Figurementioning

confidence: 99%

A prospective randomized trial comparing patent blue and methylene blue for the detection of the sentinel lymph node in breast cancer patients

Paulinelli

Freitas‐Junior

Rahal

et al. 2017

Rev. Assoc. Med. Bras.

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Introduction:Methylene blue is more widely available and less expensive than patent blue, with an apparently lower risk of anaphylaxis. Objective: The two dyes were compared regarding detection of the sentinel lymph node (SLN). Method: A prospective, randomized trial involved 142 patients with invasive breast carcinoma. Sixty-nine (49.3%) assigned to patent blue (group A) and 71 (50.70%) to methylene blue (group B). Thirty-five patients (25.0%) were clinical stage III or IV; 55 (38.7%) had axillary lymph nodes affected; and 69 (49.3%) underwent neoadjuvant chemotherapy. Two patients were excluded because the dye type was not recorded. Results: Patients and tumor characteristics were similar in both groups. SLNs were identified in 47 women (68.1%) in group A and 43 (60.6%) in group B (p=0.35). SLNs were affected in 22 cases (51.2%) in group A and 21 (48.8%) in group B (p=0.62). The SLN was the only node affected in 12 cases (54.5%) in group A and six (33.3%) in group B (p=0.18). The time and degree of difficulty involved in identifying the SLN were similar in both groups. There were no complications or allergies. Conclusion: Methylene blue performed as well as patent blue in identifying the SLN in breast cancer patients.

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Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy in Patients With Node-Positive Breast Cancer

Cited by 1,320 publications

References 19 publications

How Can Nanoparticles be used in Sentinel Node Detection?

How Can Nanoparticles be used in Sentinel Node Detection?

Management of the positive axilla in 2017

A prospective randomized trial comparing patent blue and methylene blue for the detection of the sentinel lymph node in breast cancer patients

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