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Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy Is Accurate in Breast Cancer Patients with a Clinically Negative Axillary Nodal Status at Presentation

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In breast cancer, neoadjuvant chemotherapy (NAC) is widely used in order to enable a conservative surgery. In patients treated with NAC, the use of sentinel lymph node (SLN) biopsy, which is a good predictor of the axillary nodal status in previously untreated patients, is still discussed. The aim of our study was to determine clinicopathological factors that may influence the accuracy of SLN biopsy after NAC.

Methods

Between March 2001 and December 2006, 129 patients with infiltrating breast carcinoma were studied prospectively. Preoperatively, all of them underwent NAC. At surgery, SLN biopsy followed by axillary lymph node (ALN) dissection was performed. Lymphatic mapping was done using the isotope method.

Results

The SLN identification rate was 93.8% (121/129). Fifty-six out of the 121 successfully mapped patients had positive ALN. Eight out of these 56 patients had tumor-free SLN (false-negative rate of 14.3%). The false-negative rate was correlated with larger tumor size (T1-T2 versus T3; P = 0.045) and positive clinical nodal status (N0 versus N1-N2; P = 0.003) before NAC. In particular, the false-negative rate was 0% (0/29) in N0 patients and 29.6% (8/27) in N1-N2 patients. Clinical and pathological responses to NAC did not influence the accuracy of SLN biopsy.

Conclusion

Our results show that clinical nodal status is the main clinicopathological factor influencing the false-negative rate of SLN biopsy after NAC for breast cancer. SLN biopsy after NAC can predict the ALN status with a high accuracy in patients who are clinically lymph node negative at presentation.

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References

  1. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220:391–8

    Article  PubMed  CAS  Google Scholar 

  2. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer-amulticenter validation study. N Engl J Med 1998; 339:941–6

    Article  PubMed  CAS  Google Scholar 

  3. Gordon F, Schwartz MD, MBA, Armando E, Giuliano MD, Umberto Veronesi MD. and the concensus conference committee. Human Pathology 2002; 6:579–89

  4. Schwartz GF, Giuliano AE, Veronesi U. and the Concensus Conference Committee. Proceedings of the concensus conference on the role of sentinel node biopsy in carcinoma of the breast. Breast J 2002; 8:126–38

    Article  Google Scholar 

  5. Bonadonna G, Valagussa P, Brambilla C, et al. Primary chemotherapy in operable breast cancer: eight year experience at the Milan Cancer Institute. J Clin Oncol 1998; 16:93–100

    PubMed  CAS  Google Scholar 

  6. Cohen LF, Breslin TM, Kuerer HM, et al. Identification and evaluation of axillary sentinel lymph nodes in patients with breast carcinoma treated with neoadjuvant chemotherapy. Am J Surg Pathol 2000; 24:1266–72

    Article  PubMed  CAS  Google Scholar 

  7. Nason KS, Anderson BO, Byrd DR, et al. Increased false-negative sentinzl node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 2000; 89:2187–94

    Article  PubMed  CAS  Google Scholar 

  8. Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol 2000; 18:3480–6

    PubMed  CAS  Google Scholar 

  9. Fernandez A, Cortes M, Benito E, et al. Gamma probe sentinel node localization and biopsy in breast cancer patients trated with a neoadjuvant chemotherapy scheme. Nucl Med Commun 2001; 22:361–6

    Article  PubMed  CAS  Google Scholar 

  10. Stearns V, Ewing CA, Slack R, et al. Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol 2002; 9:235–42

    Article  PubMed  Google Scholar 

  11. Tafra L, Verbanac KM, Lannin DR. Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer. Am J Surg 2001; 182:312–5

    Article  PubMed  CAS  Google Scholar 

  12. Schwartz GF, Meltzer AJ. Accuracy of axillary sentinel lymph node biopsy following neoadjuvant (induction) chemotherapy for carcinoma of breast. Breast J 2003; 9:374–9

    Article  PubMed  Google Scholar 

  13. Lang JE, Essermann LJ, Ewing CA, et al. Accuracy of selective sentinel lymphadenectomy after neoadjuvant chemotherapy: effect of clinical node status at presentation. J Am Coll Surg 2004; 199:855–62

    Article  Google Scholar 

  14. Shimazu K, Tamaki Y, Taguchi T, et al. Sentinel lymph node biopsy using periareolar injection of radiocolloid for patients with neoadjuvant chemotherapy-treated breast carcinoma. Cancer 2004;100:2555–61

    Article  PubMed  Google Scholar 

  15. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005; 23:7703–20

    Article  PubMed  Google Scholar 

  16. Kuerer HM, Hunt KK. The rationale for integration of lymphatic mapping and sentinel node biopsy in the management of breast cancer patients receiving neoadjuvant chemotherapy. Semin Breast Dis 2002; 5:80–7

    Google Scholar 

  17. Sharkey FE, Addington SL, Fowler LJ, et al. Effects of preoperative chemotherapy on the morphology of resectable breast carcinoma. Mod Pathol 1996; 9:893–900

    PubMed  CAS  Google Scholar 

  18. Kang SH, Kim SK, Kwon Y, et al. Decreased identification rate of sentinel lymph node after neoadjuvant chemotherapy. World J Surg 2004; 28:1019–24

    Article  PubMed  Google Scholar 

  19. Miller AR, Thomason VE, Yeh IT, et al. Analysis of sentinel lymph node mapping with immediate pathologic review in patients receiving preoperative chemotherapy in patients receiving preoperative chemotherapy for breast carcinoma. Ann Surg Oncol 2002; 9:243–7

    PubMed  Google Scholar 

  20. Haid A, Tausch C, Lang A, et al. Is sentinel lymph node biopsy reliable and indicated after preoperative chemotherapy in patients with breast carcinoma? Cancer 2001; 92:1080–4

    Article  PubMed  CAS  Google Scholar 

  21. Julian TB, Dusi D, Wolmark N. Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer. Am J Surg 2002; 184:315–7

    Article  PubMed  Google Scholar 

  22. Brady EW. Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer. Breast J 2002; 8:97–100

    Article  PubMed  Google Scholar 

  23. Balch GC, Mithani SK, Rchards KR, et al. Lymphatic mapping and sentinel lymphadenectomy after preoperative therapy for stage II and III breast cancer. Ann Surg Oncol 2003; 10:616–21

    Article  PubMed  Google Scholar 

  24. Mamounas EP. Sentinel lymph node biopsy after neoadjuvant systemic therapy. Surg Clin North Am 2003; 83:931–42

    Article  PubMed  Google Scholar 

  25. Piato JR, Barros AC, Pincerato KM, et al. Sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy. A pilot study. Eur J Surg Oncol 2003; 29:118–20

    Article  Google Scholar 

  26. Xin Y, Foy M, Cox DD, et al. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg 2006; 93:539–46

    Article  Google Scholar 

  27. Fraile M, Rull M, Julian FJ, et al. Sentinel node biopsy as a practical alternative to axillary lymph node dissection in breast cancer patients: an approach to its validity. Ann Oncol 2000; 11:701–5

    Article  PubMed  CAS  Google Scholar 

  28. Miltenburg DM, Miller C, Karamlou TB, et al. Meta-analysis of sentinel lymph node biopsy in breast cancer. J Surg Res 1999; 84:138–42

    Article  PubMed  CAS  Google Scholar 

  29. Kim T, Agboola O, Lyman GH. Lymphatic mapping and sentinel lymph node sampling in breast cancer: a meta-analysis. 2002 ASCO Annual Meeting Proceedings Orlando, FL, 2002. Available: http://www.asco.org/ac/11,1003,-12-002643-00-18-0016-00-19-00139,00.asp

  30. Jones JL, Zabicki K, Christian RL, et al. A comparaison of sentinel lymph node biopsy before and after neoadjuvant chemotherapy; timing is important. Am J Surg 2005;190:517–20

    Article  PubMed  Google Scholar 

  31. Cox CE, Cox JM, White LB, et al. Sentinel node biopsy before neoadjuvant chemotherapy for determining axillary status and treatment prognosis in locally advanced breast cancer. Ann Surg Oncol 2006; 13:483–90

    Article  PubMed  Google Scholar 

  32. Kinoshita T, TagasugiM, Iwamoto E, et al. Sentinel lymph node biopsy examination for breast cancer patients with clinically negative axillary lymph nodes after neoadjuvant chemotherapy. Am J Surg 2006; 191:225–9

    Article  PubMed  Google Scholar 

  33. Mamounas EP, Brown A, Anderson S, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from national surgical adjuvant breast and bowel project protocol B-27. J Clin Oncol 2005; 23:2694–702

    Article  PubMed  Google Scholar 

  34. Schrenk P, Huchreiner G, Fridik M. Sentinel node biopsy before preoperative chemotherapy for axillary lymph node staging in breast cancer. Breast J 2003;9:282–7

    Article  PubMed  Google Scholar 

  35. Ollila DW, Neuman HB, Sartor C, et al. Lymphatic mapping and sentinel lymphadenectomy prior to neoadjuvant chemotherapy in patients with large breast cancers. Am J Surg 2005;190:371–5

    Article  PubMed  Google Scholar 

  36. Chung MH, Ye W, Giuliano AE. Role of sentinel lymph node dissection in the management of large (>5 cm) ivasive breast cancer. Ann Surg Oncol 2001; 8:688–92.

    PubMed  CAS  Google Scholar 

  37. Lelievre L, Houvenaeghel G, Buttarelli M, et al. Value of the sentinel lymph node procedure in patient with large size breast cancer cancer. Ann Surg Oncol 2006; 14:621–6

    Article  PubMed  Google Scholar 

  38. Bredosian I, Reynolds C, Mick R, et al. Accuracy of sentinel lymph node biopsy in patients with large primary breast tumors. Cancer 200; 88:2540–5

  39. Mullan MH, Deacock SJ, Quiney NF, Kissin MW. Anaphylaxis to patent blue dye during sentinel lymph node biopsy for breast cancer. Eur J Surg Oncol 2001; 27:218–9

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Centre Jean Perrin, Clermont-Ferrand, France

    P. Gimbergues (MD), G. Le Bouedec (MD) & J. Dauplat (MD, PhD)

  2. Department of Clinical Research, Centre Jean Perrin, Clermont-Ferrand, France

    C. Abrial (PhD)

  3. Department of Clinical Oncology, Centre Jean Perrin, Clermont-Ferrand, France

    X. Durando (MD, PhD) & M. A. Mouret-Reynier (MD)

  4. Department of Nuclear Medicine, Centre Jean Perrin, Clermont-Ferrand, France

    F. Cachin (MD) & J. Maublant (MD, PhD)

  5. Department of Pathology, Centre Jean Perrin, Clermont-Ferrand, France

    F. Penault-Llorca (MD, PhD)

  6. Department of Statistics, Centre Jean Perrin, Clermont-Ferrand, France

    F. Kwiatkowski (MSc)

  7. Department of Radiotherapy, Centre Jean Perrin, 58, rue Montalembert - BP 392, Clermont-Ferrand Cedex1, 63011, France

    A. Tchirkov (MD, PhD)

  8. Faculty of Medicine, CHU, Clermont-Ferrand, France

    A. Tchirkov (MD, PhD)

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  1. P. Gimbergues
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  2. C. Abrial
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  3. X. Durando
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  4. G. Le Bouedec
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Correspondence to A. Tchirkov.

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Gimbergues, P., Abrial, C., Durando, X. et al. Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy Is Accurate in Breast Cancer Patients with a Clinically Negative Axillary Nodal Status at Presentation. Ann Surg Oncol 15, 1316–1321 (2008). https://doi.org/10.1245/s10434-007-9759-z

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  • DOI: https://doi.org/10.1245/s10434-007-9759-z

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