Cancer Res Treat.  2015 Jan;47(1):26-33. 10.4143/crt.2013.208.

Prospective Evaluation of the Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Negative Axillary Conversion after Neoadjuvant Chemotherapy

• Lee HD
• Ahn SG
• Lee SA
• Lee HM
• Jeong J

• KMID: 2380387
• DOI: http://doi.org/10.4143/crt.2013.208

Abstract

PURPOSE
Tumor response to neoadjuvant chemotherapy (NAC) may adversely affect the identification and accuracy rate of sentinel lymph node biopsy (SLNB). This study was conducted to evaluate the feasibility of SLNB in node-positive breast cancer patients with negative axillary conversion after NAC.
MATERIALS AND METHODS
Ninety-six patients with positive nodes at presentation were prospectively enrolled. 18Fluorodeoxyglucose-positron emission tomography (18F-FDG PET) and ultrasonography were performed before and after NAC. A metastatic axillary lymph node was defined as positive if it was positive upon both 18F-FDG PET and ultrasonography, while it was considered negative if it was negative upon both 18F-FDG PET and ultrasonography.
RESULTS
After NAC, 55 cases (57.3%) became clinically node-negative, while 41 cases (42.7%) remained node-positive. In the entire cohort, the sentinel lymph node (SLN) identification and false-negative rates were 84.3% (81/96) and 18.4% (9/49), respectively. In the negative axillary conversion group, the results of SLNB showed an 85.7% (48/55) identification rate and 16.7% (4/24) false-negative rate.
CONCLUSION
For breast cancer patients with clinically positive nodes at presentation, it is difficult to conclude whether the SLN accurately represents the metastatic status of all axillary lymph nodes, even after clinically negative node conversion following NAC.

Keyword

Breast neoplasms; Neoadjuvant therapy; Sentinel lymph node biopsy; Predictive value of tests

MeSH Terms

Breast Neoplasms*
Cohort Studies
Drug Therapy*
Fluorodeoxyglucose F18
Humans
Lymph Nodes
Neoadjuvant Therapy
Predictive Value of Tests
Prospective Studies*
Sentinel Lymph Node Biopsy*
Ultrasonography
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1. Various treatment outcomes according to axillary node status reflect an uneven tumor response to chemotherapy by each metastatic lymph node. Residual non-sentinel node metastasis after chemotherapy could raise concerns regarding application of sentinel lymph node (SLN) biopsy for patients receiving neoadjuvant chemo-therapy (red arrow).

• 

  Fig. 2. Study overview. 18F-FDG PET, 18Fluorodeoxyglucose-positron emission tomography; US, ultrasonography; ALND, axillary lymph node dissection; SLNB, sentinel lymph node biopsy.

Reference

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