J Breast Cancer.  2015 Mar;18(1):22-28. 10.4048/jbc.2015.18.1.22.

Sentinel Lymph Node Biopsy Alone after Neoadjuvant Chemotherapy in Patients with Initial Cytology-Proven Axillary Node Metastasis

• Kim JY
• Kim MK
• Lee JE
• Jung Y
• Bae SY
• Lee SK
• Kil WH
• Kim SW
• Kim KS
• Nam SJ
• Han S

• KMID: 2286333
• DOI: http://doi.org/10.4048/jbc.2015.18.1.22

Abstract

PURPOSE
Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis.
METHODS
From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results.
RESULTS
At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050).
CONCLUSION
SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection.

Keyword

Axilla; Breast neoplasms; Neoadjuvant therapy; Neoplasm metastasis; Sentinel lymph node biopsy

MeSH Terms

Axilla
Breast Neoplasms
Diagnosis
Disease-Free Survival
Drug Therapy*
Humans
Lymph Nodes
Neoadjuvant Therapy
Neoplasm Metastasis*
Recurrence
Retrospective Studies
Sentinel Lymph Node Biopsy*

Figure

• 

  Figure 1 Summary of patient selection and grouping of patients with initial cytology-proven nodal disease at presentation. ALN=axillary lymph node; SLNB=sentinel lymph node biopsy; ALND=axillary lymph node dissection; SLN=sentinel lymph node.

• 

  Figure 2 Kaplan-Meier survival curves for overall survival and disease-free survival in all groups. The p-value was calculated using log-rank test. The comparison of overall survival (A) in groups 1, 2, 3, 4, and 5 showed no statistical significant difference. There was a significant difference in the disease-free survival rate (B) between groups 1 and 4 (77.1% vs. 85.4%, p=0.031).

• 

  Figure 3 Kaplan-Meier survival curves for axillary event-free survival in groups 1, 2, and 4 (3.3%, 5.0%, and 1.3%, log-rank test, p>0.05).

• 

  Figure 4 Kaplan-Meier survival curves for the disease-free survival of subgroups according to the hormone receptor status. The p-value was calculated using log-rank test. The disease-free survival curve of group 1 was early censored and could not be compared statistically in the hormone-positive subgroup (A). In hormone receptor-negative group (B), there was no statistical difference of recurrence between the group 1 versus group 2, and group 1 versus group 4 (p=0.354 and p=0.401).

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