J Breast Cancer.  2011 Jun;14(2):147-152. 10.4048/jbc.2011.14.2.147.

Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Initial Axillary Lymph Node Metastasis after Primary Systemic Therapy

• Kang E
• Chung IY
• Han SA
• Kim SM
• Jang M
• Lyou CY
• Park SY
• Kim JH
• Kim YJ
• Kim SW

• KMID: 2286515
• DOI: http://doi.org/10.4048/jbc.2011.14.2.147

Abstract

PURPOSE
Primary systemic therapy (PST) downstages up to 40% of initial documented axillary lymph node (ALN) metastases in breast cancer. The current surgical treatment after PST consists of breast tumor resection and axillary lymph node dissection (ALND). This strategy, however, does not eliminate unnecessary ALND in patients with complete remission of axillary metastases. The aim of this study was to examine the accuracy of sentinel lymph node biopsy (SLNB) after PST among patients with documented ALN metastasis at presentation and to identify the rate of pathologic complete-remission (CR) with ALN after PST.
METHODS
We analyzed 66 patients with ALN metastasis that was pathologically proven preoperatively who underwent SLNB and concomitant ALND after PST. Axillary ultrasound (AUS) was used to evaluate the clinical response of initially documented ALN metastasis after PST. Intraoperative lymphatic mapping was performed using blue dye with or without radioisotope.
RESULTS
After PST, 34.8% of patients had clinical CR of ALN on AUS and 28.8% patients had pathologic CR of ALN. The overall success rate of SLNB after PST was 87.9%, and the sentinel lymph node identification rate in patients with clinical CR was 95.7%. In patients with successful lymphatic mapping, 70.7% of patients had residual axillary metastases. The overall accuracy and false-negative rate were 87.9% and 17.1% in all patients: 95.5% and 10.0% in patients with clinical CR of ALN, and 83.3% and 19.4% in patients with residual axillary disease after PST.
CONCLUSION
Our findings suggest that SLNB may be feasible in patients with initial documented ALN metastasis who have clinical CR for metastatic ALN after PST. Further investigation in a prospective setting should be performed to confirm our results.

Keyword

Breast neoplasms; Primary systemic therapy; Sentinel lymph node biopsy

MeSH Terms

Breast
Breast Neoplasms
Humans
Lymph Node Excision
Lymph Nodes
Neoplasm Metastasis
Nitriles
Pyrethrins
Sentinel Lymph Node Biopsy
Nitriles
Pyrethrins

Figure

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  Figure 1 New suggested algorithm to prevent unnecessary axillary lymph node dissection after primary systemic therapy. ALN=axillary lymph node; FNAC=fine needle aspiration cytology; AUS=axillary ultrasound; CR=complete remission.

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