Sentinel node biopsy after neoadjuvant treatment in breast cancer: Five-year follow-up of patients with clinically node-negative or node-positive disease before treatment

Galimberti, Viviana; Fontana, Sabrina Kahler Ribeiro; Maisonneuve, Patrick; Steccanella, Francesca; Vento, Anna Rita; Intra, Mattia; Naninato, Paola; Caldarella, Pietro; Iorfida, Monica; Colleoni, Marco; Viale, Giuseppe; Grana, Chiara Maria; Rotmensz, Nicole; Luini, Alberto

doi:10.1016/j.ejso.2015.11.019

Cited by 142 publications

(89 citation statements)

References 19 publications

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“…At a median follow-up of 61 months, there were no axillary failures in the 70 patients who initially presented with cN1/N2 disease, had negative sentinel nodes after NAC, and received SLNB alone. 20 Although these results are promising, the safety of lesser surgery in the axilla after NAC in clinically node-positive patients remains uncertain, and the ultimate utility of this approach in LABC patients can only be determined in a clinical trial.…”

Section: Discussionmentioning

confidence: 99%

Tumor Biology Predicts Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients Presenting with Locally Advanced Breast Cancer

et al. 2017

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Background Neoadjuvant chemotherapy (NAC) is used to convert patients with inoperable locally advanced breast cancer (LABC) to operability, but has not traditionally been used to avoid mastectomy or axillary dissection in this subset. The purpose of this study was to determine rates of pathologic complete response (pCR) in LABC patients and identify factors predictive of pCR to determine if responding patients might be suitable for limited surgery. Methods From 2006-2016, 1522 patients received NAC followed by surgery; 321 had advanced disease in the breast (cT4) and/or in the nodes (cN2/N3). pCR rates were assessed by T and N stage, and receptor subtype. Results Of 321 LABC patients, 223 were cT4, 77 cN2, and 82 cN3. 43% were hormone receptor (HR)+/HER2-, 23% triple negative, and 34% HER2+. The overall pCR rate was 25% and differed by receptor subtype (HR+/HER2- 7%; triple negative 23%; HER2+ 48%;p<0.001). Breast pCR occurred in 27% and was similar in T4 vs. non-T4 disease (29% vs. 22%,p=0.26). Nodal pCR was achieved in 38% of cN+ patients and did not differ by nodal stage (cN1 43%, cN2 36%, cN3 32%; p=0.23). Nodal pCR was significantly more common than breast pCR (p=0.014) across all tumor subtypes. Receptor subtype was the only predictor of overall pCR (p<0.001). Conclusion In patients with LABC, pCR after NAC was seen in 25%, and did not differ by T or N stage. Tumor biology, but not extent of disease, predicted pCR. Studies assessing feasibility of surgical downstaging with NAC in LABC patients are warranted.

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Section: Discussionmentioning

confidence: 99%

Tumor Biology Predicts Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients Presenting with Locally Advanced Breast Cancer

et al. 2017

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“…Whether the performance of axillary lymph node dissection may be avoided in these cases remains unknown. According to the ACOSOG Z0011 (13) and EORTC AMAROS (12) studies, radiotherapy to the axilla minimally affected by metastasis may promote survival rates similar to those of patients undergoing axillary lymph node dissection (7,32). However, an important study reported that positive preoperative cytology indicates a greater extension of axillary metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

Comparative study between ultrasound-guided fine needle aspiration cytology of axillary lymph nodes and sentinel lymph node histopathology in early-stage breast cancer

et al. 2017

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Abstract. The replacement of sentinel lymph node biopsy (SNB) by ultrasound-guided fine-needle aspiration (US-guided FNA) cytology of axillary lymph nodes is controversial, despite the simplicity and reduced cost of the latter. In the present study, US-guided FNA was performed in 27 patients with early-stage breast cancer for comparison with SNB. Data were analyzed by calculation of sample proportions. Tumor subtypes included invasive ductal carcinoma (85%), invasive lobular carcinoma (7%), and tubular and metaplastic carcinoma (4%). FNA had a sensitivity of 45%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 73%. Axillary lymph node cytology obtained by US guided-FNA in patients with breast cancer had a specificity similar to that of sentinel lymph node histopathology in the presence of axillary node metastases. However, when lymph node cytology is negative, it does not exclude the existence of metastatic implants, due to its low sensitivity in comparison to sentinel lymph node histopathology.

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“…Axillary relapse was observed in only 1 (0.2%) patient after a follow-up of 3 years. In a retrospective study of 157 cN0 ypN0(sn) patients without completion ALND, Galimberti et al [4 ]observed only 1 (0.6%) axillary relapse after 5 years.…”

Section: Current Standard Of Slnb In Cn0 Patientsmentioning

confidence: 99%

“…2 recently published retrospective single-center studies provided survival data for cN+ patients undergoing different types of axillary staging, axillary surgery, and RT. Galimberti et al [4 ]reported on a limited retrospective cohort of 147 initially cN+ patients who converted to cN- after NACT. SLNB was performed after NACT and was negative in 70 (47.6%) patients; the remaining 77 patients with SLN metastases received ALND.…”

Section: Current Standard In Cn1 Patientsmentioning

confidence: 99%

Current Status and Future Perspectives of Axillary Management in the Neoadjuvant Setting

et al. 2018

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Axillary surgery has undergone considerable changes in recent years, especially in relation to patients who undergo neoadjuvant chemotherapy (NACT). Due to constantly decreasing rates of recurrence and death from breast cancer, modern surgical strategies aim at de-escalating the extent of local treatment and avoiding unnecessary procedures. This relates especially to lymph node surgery which is associated with considerable morbidity. In patients who initially present with clinically node-negative disease, sentinel lymph node biopsy (SLNB) is increasingly performed after NACT. The determination of the post-NACT nodal status does not only spare patients from additional surgery but also allows the assessment of pathologic complete response which is increasingly becoming an important tool for treatment planning. Since more than 70% of these patients have a ypN0 status after NACT, future trials will aim to identify patients who might be spared any axillary surgery after NACT. In patients who initially present with positive lymph nodes, the success rates of SLNB in terms of detection and accuracy are less favorable compared to those in patients who undergo primary surgery. The clinical significance of this is unclear. To reduce unnecessary axillary dissection in patients with cN1ycN0 status, prospective outcome data after SLNB without further lymph node removal are urgently needed. Improvements in surgical technique by localizing positive nodes at the time of diagnosis and removing them in a targeted surgical procedure (targeted axillary dissection) are under evaluation. Risk assessment and patient selection (including gene expression profiles) might be other ways of safely omitting axillary dissection.

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Sentinel node biopsy after neoadjuvant treatment in breast cancer: Five-year follow-up of patients with clinically node-negative or node-positive disease before treatment

Cited by 142 publications

References 19 publications

Tumor Biology Predicts Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients Presenting with Locally Advanced Breast Cancer

Tumor Biology Predicts Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients Presenting with Locally Advanced Breast Cancer

Comparative study between ultrasound-guided fine needle aspiration cytology of axillary lymph nodes and sentinel lymph node histopathology in early-stage breast cancer

Current Status and Future Perspectives of Axillary Management in the Neoadjuvant Setting

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