SP8.1.7 Sentinel Lymph Node Biopsy or Neoadjuvant Chemotherapy- What comes first?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Smriti Karki ◽  
Yasmin Hassen ◽  
Arunmoy Chakravorty ◽  
Karolina Ajauskaite ◽  
Ekambaram Dinkara Babu
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Neoadjuvant Chemotherapy ◽  
Early Breast Cancer ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Nodal Disease ◽  
Node Biopsy

Abstract Aims NICE guidelines have not defined the timing of Sentinel Lymph Node Biopsy (SLNB) with respect to neoadjuvant chemotherapy (NACT). While there is an ongoing debate, the emerging consensus is in favour of SLNB following NACT in clinically node-negative (cN0) patients which confers the advantage of better prognostic outcomes as a negative SLNB negates further Axillary Lymph Node Dissection (ALND) and prevents patients having further unnecessary surgery. Thus, the aim of the study was to establish whether unnecessary ALND can be safely avoided by performing SLNB after NACT. Method Retrospective case records review of all patients treated with ALND at a single institution was undertaken from January 2018 to December 2019. Results 73 patients had ALND in this time frame. Patients received SLNB before NACT and ALND was performed if they were found node-positive on SLNB. Out of 73 patients, 24 patients had no further nodal disease, 26 had 1-2 macrometastasis and 23 had 3 or more macrometastasis on ALND. 57/73 patients had early breast cancer (T1/T2). 21/57 were cN0 but and 5/21 had NACT following SLNB and ALND after NACT. Of the 5 patients, 2 (40%) had no nodal disease on ALND. Conclusion 40% patients could have avoided ALND if SLNB was done after NACT. Also, 68% (50/73) patients who had ALND only had <2 lymph node macrometastasis. This data implies that patients with early breast cancer may be getting subjected to a second operation which not only is unnecessary but also may have debilitating complications.

Axillary Recurrence after Sentinel Lymph Node Biopsy for Breast Cancer

2010 ◽  
Vol 76 (10) ◽  
pp. 1127-1129 ◽  
Author(s):  
Christine Dauphine ◽  
Denis Nemtsev ◽  
David Rosing ◽  
Hernan I. Vargas
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Neoadjuvant Chemotherapy ◽  
Lymph Node Biopsy ◽  
Axillary Recurrence ◽  
Axillary Lymph ◽  
Node Biopsy

Sentinel lymph node biopsy (SLNB) is routinely performed as an axillary staging procedure for breast cancer. Although the reported false-negative rate approaches 10 per cent, this does not always lead to axillary recurrence. We previously reported an axillary recurrence rate of 1 per cent at a median follow-up of 2 years. Our objective is to determine the rate of axillary recurrence with longer follow-up. A retrospective review of patients with invasive breast cancer and a negative SLNB treated between 2001 and 2005 was performed. Cases where neoadjuvant therapy was used or where isolated tumor cells (ITCs) were found were included, whereas those with fewer than 18 months of follow-up were excluded. One (0.7%) out of 139 patients had an axillary recurrence after a median follow-up of 52 months. No patient who underwent neoadjuvant chemotherapy or with ITCs had axillary recurrence. Twelve (8.6%) patients have died, with death attributed to breast cancer in three. Our study demonstrates that axillary recurrence after SLNB remains a rare event after a median follow-up of 52 months, despite including potentially higher risk scenarios such as where neoadjuvant chemotherapy is used and ITCs are found. Therefore, axillary lymph node dissection can safely be avoided in patients where SLNB is negative.

scholarly journals AXILLARY LYMPH NODE DISSECTION IN BREAST CANCER PATIENTS. THE ROLE OF SENTINEL LYMPH NODE BIOPSY

2015 ◽  
Vol 62 (4) ◽  
pp. 351-356
Author(s):  
Nicolae Bacalbasa ◽  
◽  
Olivia Ionescu ◽  
Irina Balescu ◽  
◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Early Breast Cancer ◽  
Lymph Node Biopsy ◽  
Controlled Trials ◽  
Axillary Lymph ◽  
Randomized Controlled ◽  
Node Biopsy

Rationale. Since its introduction in the early 1990s, sentinel lymph node biopsy (SLNB) is regarded as the standard treatment for patients with clinically negative axillary lymph nodes (LNs) on initial presentation. Classically, when the SLN biopsy is negative, the axillary LN dissection (ALND) is no further necessary. On the other hand, performing complete ALND in case of a positive SLNB is controversial, recent data from randomized controlled studies suggesting that, in these cases, the tumor biology has a greater impact on the adjuvant treatment decision than the completion of an ALND. Objective. The aim of this review is to ascertain whether axillary LN surgery has survival benefits in women with early breast cancer and SLN involvement, either micro-metastatic or macro-metastatic. Moreover, it tries to assess the value of SLN biopsy before and after primary systemic chemotherapy and its role in the staging of the axilla in locally recurrent breast cancer. Materials and method. We searched Pubmed, Medline, the Cochrane Register of Controlled Trials and G.I.N (Guidelines International Network) databases for English language articles about the need of ALND in women with both positive and negative SLNs using controlled vocabulary (e.g. “breast cancer”) and key words (e.g “sentinel lymph node”, “axilla dissection”). The analysis was restricted to retrospective studies and randomized controlled trials focusing on survival benefits in terms overall (OS) or disease-free survival (DFS). Conclusions. There is increasing evidence which indicates that ALND can be avoided in a specific group of patients with early breast cancer, even though the SLNB is positive. A correlation between the clinico-pathological features of the breast cancer and the probability of residual disease in the axilla, could allow the selection of cases in which ALND can be omitted. In the context of neo-adjuvant chemotherapy, it is not yet established if positive SLNs could be converted to negative SLNs after chemotherapy as the rate of false-negative results is still high.

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