Sentinel lymph node biopsy in patients with operable breast cancer treated with neoadjuvant chemotherapy

A C Rebollo-Aguirre, M Gallego-Peinado, S Menjón-Beltrán, J García-García, E Pastor-Pons, C E Chamorro-Santos, C Ramos-Font, A Salamanca-Ballesteros, J M Llamas-Elvira, N Olea-Serrano
Revista Española de Medicina Nuclear e Imagen Molecular 2012, 31 (3): 117-23

AIM: To evaluate the accuracy of sentinel lymph node biopsy (SLNB) in operable breast cancer patients treated with neoadjuvant chemotherapy (NAC).

MATERIALS AND METHODS: Between January 2008-2011, 88 women, mean age 49.4 years, with infiltrating breast carcinoma, were studied prospectively. Patients were T1-3, N0-1, M0. Prior to surgery, the patients received chemotherapy (epirubicin/cyclophosphamide, docetaxel), and trastuzumab in Her2/neu-positive patients. Axillary status was established by physical examination, ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB, followed by complete axillary lymph node dissection (ALND). Sentinel lymph node (SLN) were examined by frozen sections, hematoxylin-eosin staining and immunohistochemical analysis or One Step Nucleic Acid Amplification (OSNA).

RESULTS: Mean tumor size: 3.5 cm. Histologic type: 69 invasive ductal, 16 invasive lobular and 3 others. Thirty seven patients had clinical/ultrasound node-positive at presentation. Clinical response of primary tumor to NAC: complete in 38, partial in 45, and stable disease in 5 patients. A pathological complete response was achieved in 25. All patients were clinically node-negative after NAC. SLN identification rate was 92.0%. Six of 7 patients in whom SLN was not found had clinical/ultrasound positive axilla before NAC. SLN accurately determined the axillary status in 96.5%. False negative rate was 8.3%. In 69.4% of patients, SLN was the only positive node. The mean number of SLN removed was 1.7 and nodes resected from the ALND were 13.2.

CONCLUSION: SLN biopsy after NAC can predict the axillary status with a high accuracy in patients with breast cancer, avoiding unnecessary ALND.

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