Ann Surg Treat Res.  2021 Jun;100(6):305-312. 10.4174/astr.2021.100.6.305.

Targeted axillary biopsy and sentinel lymph node biopsy for axillary restaging after neoadjuvant chemotherapy

• Gurleyik G
• Aksu SA
• Aker F
• Tekyol KK
• Tanrikulu E
• Gurleyik E

• KMID: 2516223
• DOI: http://doi.org/10.4174/astr.2021.100.6.305

Abstract

Purpose
Accurate restaging of the axilla after neoadjuvant chemotherapy (NAC) is an important issue to ensure deescalating axillary surgery in patients with initial metastatic nodes. We aimed to present our results of targeted axillary biopsy (TAB) combined with sentinel lymph node biopsy (SLNB) for axillary restaging after NAC.
Methods
In 64 breast cancer patients who underwent NAC, biopsy-proven positive nodes were marked with clips before NAC, and ultrasound-guided wire localization of clip-marked nodes was performed after NAC. Patients underwent TAB and SLNB for post-NAC axilla restaging.
Results
Identification rates of post-NAC TAB and SLNB were 98.4% and 87.5%, respectively (P = 0.033). Histopathology revealed a nodal pathologic complete response (pCR) rate of 47% in which axillary lymph node dissection (ALND) was avoided. TAB alone and SLNB alone detected residual disease in 29 (85.3%) and 20 (58.8%) patients (P = 0.029), respectively. Whereas rates of up to 97% had been achieved with a combination of TAB and SLNB. The pCR rates after NAC were 64.3% for human epidermal growth factor receptor 2 positive and triple-negative tumors and 13.6% in luminal tumors (P = 0.0002).
Conclusion
Pathologic analysis following TAB combined with SLNB revealed the pCR rates to NAC in a considerable number of patients that provided de-escalation of axillary surgery. A combination of SLNB and TAB was found to be an accurate procedure in establishing residual nodal disease. This combined procedure in patients with initially positive nodes was a reliable method for post-NAC axillary restaging.

Keyword

Breast; Lymph nodes; Neoplasms; Pathologic response; Surgery

Figure

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  Fig. 1 Specimen radiography after postneoadjuvant chemotherapy targeted axillary biopsy. Marker clip is visualized in hypoechoic cortex of the excised lymph node which is localized with marking wire.

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