J Breast Cancer.  2018 Dec;21(4):433-441. 10.4048/jbc.2018.21.e54.

Use of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Patients with Axillary Node-Positive Breast Cancer in Diagnosis

• Choi HJ
• Kim I
• Alsharif E
• Park S
• Kim JM
• Ryu JM
• Nam SJ
• Kim SW
• Yu J
• Lee SK
• Lee JE

• KMID: 2429822
• DOI: http://doi.org/10.4048/jbc.2018.21.e54

Abstract

PURPOSE
This study aimed to evaluate the effects of sentinel lymph node biopsy (SLNB) on recurrence and survival after neoadjuvant chemotherapy (NAC) in breast cancer patients with cytology-proven axillary node metastasis.
METHODS
We selected patients who were diagnosed with invasive breast cancer and axillary lymph node metastasis and were treated with NAC followed by curative surgery between January 2007 and December 2014. We classified patients into three groups: group A, negative sentinel lymph node (SLN) status and no further dissection; group B, negative SLN status with backup axillary lymph node dissection (ALND); and group C, no residual axillary metastasis on pathology with standard ALND.
RESULTS
The median follow-up time was 51 months (range, 3-122 months) and the median number of retrieved SLNs was 5 (range, 2-9). The SLN identification rate was 98.3% (234/238 patients), and the false negative rate of SLNB after NAC was 7.5%. There was no significant difference in axillary recurrence-free survival (p=0.118), disease-free survival (DFS; p=0.578) or overall survival (OS; p=0.149) among groups A, B, and C. In the subgroup analysis of breast pathologic complete response (pCR) status, there was no significant difference in DFS (p=0.271, p=0.892) or OS (p=0.207, p=0.300) in the breast pCR and non-pCR patients.
CONCLUSION
These results suggest that SLNB can be feasible and oncologically safe after NAC for cytology-determined axillary node metastasis patients and could help reduce arm morbidity and lymphedema by avoiding ALND in SLN-negative patients.

Keyword

Breast neoplasms; Lymph node excision; Neoadjuvant therapy; Sentinel lymph node biopsy

MeSH Terms

Arm
Breast Neoplasms*
Breast*
Diagnosis*
Disease-Free Survival
Drug Therapy*
Follow-Up Studies
Humans
Lymph Node Excision
Lymph Nodes
Lymphedema
Neoadjuvant Therapy
Neoplasm Metastasis
Pathology
Polymerase Chain Reaction
Recurrence
Sentinel Lymph Node Biopsy*

Figure

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

• 

  Figure 2 Kaplan-Meier curves for disease-free survival (A) and overall survival (B) between combined groups A–C and node-positive groups.

• 

  Figure 3 Kaplan-Meier curves for axillary recurrence-free survival (A), disease-free survival (B), and overall survival (C) among groups A, B, and C.

• 

  Figure 4 Kaplan-Meier curves for disease-free survival and overall survival among groups A, B, and C in hormone receptor (HR)-positive (A) and HR-negative (B) patients.

• 

  Figure 5 Kaplan-Meier curves for disease-free survival and overall survival among groups A, B, and C in human epidermal growth factor receptor 2 (HER2)-positive (A) and HER2-negative (B) patients.

• 

  Figure 6 Kaplan-Meier curves for disease-free survival and overall survival among groups A, B, and C in breast pathologic complete response (pCR) (A) and non-pCR (B) patients.

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