J Breast Cancer.  2018 Dec;21(4):442-446. 10.4048/jbc.2018.21.e49.

Internal Mammary Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer

• Bi Z
• Chen P
• Liu J
• Liu Y
• Qiu P
• Yang Q
• Zheng W
• Wang Y

• KMID: 2429823
• DOI: http://doi.org/10.4048/jbc.2018.21.e49

Abstract

PURPOSE
The definition of nodal pathologic complete response (pCR) after a neoadjuvant chemotherapy (NAC) just included the evaluation of axillary lymph node (ALN) without internal mammary lymph node. This study aimed to evaluate the feasibility of internal mammary-sentinel lymph node biopsy (IM-SLNB) in patients with breast cancer who underwent NAC.
METHODS
From November 2011 to 2017, 179 patients with primary breast cancer who underwent operation after NAC were included in this study. All patients received radiotracer injection with modified injection technology. IM-SLNB would be performed on patients with internal mammary sentinel lymph node (IMSLN) visualization.
RESULTS
Among the 158 patients with cN+ disease, the rate of nodal pCR was 36.1% (57/158). Among the 179 patients, the visualization rate of IMSLN was 31.8% (57/179) and was 12.3% (7/57) and 87.7% (50/57) among those with cN0 and cN+ disease, respectively. Furthermore, the detection rate of IMSLN was 31.3% (56/179). The success rate of IM-SLNB was 98.2% (56/57). The IMSLN metastasis rate was 7.1% (4/56), and all of them were accompanied by ALN metastasis. The number of positive ALNs in patients with IMSLN metastasis was 3, 6, 8, and 9. The pathology nodal stage had been changed from pN1/pN2 to pN3b. The pathology stage had been changed from IIA/IIIA to IIIC.
CONCLUSION
Patients with visualization of IMSLN should perform IM-SLNB after NAC, especially for patients with cN+ disease, in order to complete lymph nodal staging. IM-SLNB could further improve the definition of nodal pCR and guide the internal mammary node irradiation.

Keyword

Breast neoplasms; Neoadjuvant therapy; Sentinel lymph node biopsy

MeSH Terms

Biopsy
Breast Neoplasms*
Breast*
Drug Therapy*
Humans
Lymph Nodes
Neoadjuvant Therapy
Neoplasm Metastasis
Pathology
Polymerase Chain Reaction
Sentinel Lymph Node Biopsy*

Figure

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  Figure 1 Surgical findings of internal mammary-sentinel lymph node biopsy (IM-SLNB). (A) IM-SLNB using the mastectomy incision. (B) IM-SLNB using the breast-conserving surgery incision.IMSLN=internal mammary sentinel lymph node.

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