The Oncologic Safety of Sentinel Lymph Node Biopsy in Patients with Node-Positive Breast Cancer with Complete Response to Neoadjuvant Chemotherapy: A Single-Center Experience

Abstract

Objective. To evaluate the efficiency and safety of sentinel lymph node biopsy (SLNB) in patients with breast cancer with complete response to neoadjuvant chemotherapy (NAC). Methods. Ninety-two consecutive (T1-4 and N1-2) patients with breast cancer who had pathologic and/or clinical and radiologic axillary lymph node involvement were included. All patients received NAC. Patients with a clinical and radiologic complete response in the axilla after NAC underwent SLNB. Pathologic complete response (ypCR) was defined as the absence of residual invasive and in situ cancer, and near-complete response (ypNCR) represented in situ and/or ≤ 1 mm residual tumor in the breast and/or presence of malignant cell clusters (≤0.2 mm) and/or micrometastases (≤2.0 mm) in the axillary lymph nodes (ALN) (ypTis/T1mi, ypN0i+/pN1mi). Results. The mean age of the 92 patients was 49.6 ± 10.3 years and the mean follow-up was 34.0 ± 17.8 months. With respect to breast tumors, 23 (25.0%) patients had complete and 14 (15.2%) had a near-complete response to NAC. Complete response in ALN was obtained in 39 (42.4%) patients and near-complete in six (6.5%) patients. The overall survival of the 33 patients who achieved ypCR and ypNCR was 100% and the remaining 59 patients with partial or no response to NAC was 83.1% at a mean follow-up of 34 months ( p = 0.063 ). Conclusions. In this study, no event developed in cases with ypCR and ypNCR in the breast and axilla. The persistence of the same results in long-termfollow-ups may enable the use of ypNCR as a positive prognostic marker in addition to ypCR.

Absence of post-treatment changes in sentinel lymph nodes does not translate into increased regional recurrence rate in initially node-positive breast cancer patients

“…In our cohort of 82 patients with cN + disease who were ypN0 after SLNB only, there was only one (1.2%) isolated axillary recurrence during a median follow-up of 41 months. The regional recurrence rate in our cohort is within the range of previously published studies (0–1.6%) [ 11 , 17 – 20 ]. The patient with regional recurrence underwent salvage ALND and is disease free 28 months after ALND.…”

“…Consistent with the study by Piltin et al, patients with ITC were classified as ypN0 in our study, although this is still controversial in the neoadjuvant setting [ 11 ]. Patients with ITC seem to carry a better prognosis than patients with macrometastases, but it is not entirely clear whether they can be classified as pCR/ypN0 [ 20 – 22 ]. The ongoing ICARO study may provide additional clarity on the oncologic outcomes for patients with ITC who undergo ALND, nodal RT or observation only after SLNB.…”

Absence of post-treatment changes in sentinel lymph nodes does not translate into increased regional recurrence rate in initially node positive breast cancer patients

“…Consistent with the study by Piltin et al, patients with ITC were classi ed as ypN0 in our study, although this is still controversial in the neoadjuvant setting [11]. Patients with ITC seem to have a better prognosis than patients with macrometastases, but it is not entirely clear whether they can be classi ed as pCR/ypN0 [20][21][22]. The ongoing ICARO study may provide additional clarity on the oncologic outcomes for patients with ITC who undergo ALND, nodal RT or observation only after SLNB.…”

“…In our cohort of 82 patients with cN + disease who were ypN0 after SLNB only, there was only one (1.2%) isolated axillary recurrence during a median follow-up of 41 months. The regional recurrence rate in our cohort is within the range of previously published studies (0-1.6%) [11,[17][18][19][20]. The patient with regional recurrence underwent salvage ALND and is disease free 28 months after ALND.…”

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

“…Tercan et al evaluated the oncologic safety of SLNB in BC patients who were then submitted to NACT, with the pathologically and/or clinically and radiologically metastatic involvement of axillary lymph nodes at the time of diagnosis [64].…”