Association between tumor biology and occult lymph node metastases before and after primary neoadjuvant therapy (NAT) for patients with early breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 518-518
Author(s):  
Hans-Christian Kolberg ◽  
Cornelia Kolberg-Liedtke ◽  
Maja Krajewska ◽  
Ingo Bauerfeind ◽  
Tanja N. Fehm ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Early Breast Cancer ◽  
Lymph Node Metastases ◽  
Axillary Dissection ◽  
Triple Negative ◽  
Tumor Biology ◽  
Her2 Positive ◽  
Before And After ◽  
Node Metastases

518 Background: Scientific efforts aim at a reduction of axillary morbidity through reduced axillary intervention among patients with early breast cancer. However, it is still unclear if this approach is feasible in all subtypes based on their risk of axillary involvement. We analyzed the association of tumor biology and occult axillary involvement with data from arms A and B of the SENTINA trial (Kühn T et al., Lancet Oncol 2013). Methods: Patients were included if they presented with a clinically negative axilla before NAT (arms A and B) and stratified according to tumor biology. All patients received SLNB before NAT, in cases of negative SLNB without further axillary surgery (Arm A) and in cases of positive SLNB (Arm B) with SLNB and axillary dissection after NAT. Logistic and linear regression analyses were carried out to evaluate the association between tumor biology and axillary involvement before and after NAT. Results: Of the 1022 patients in arms A and B of the SENTINA trial 926 were evaluable for this analysis. Of these, 27.9% had triple negative (TN), 16.3% hormone receptor (HR) and HER2 positive (triple positive = TP), 47.6% HR positive and HER2 negative (luminal) and 8.2% HR negative and HER2 positive (HER2) tumors. 39.7% of the luminal, 28.9% of the HER2, 19% of the TN and 47% of the TP tumors had involved SLN before NAT. Subgroup comparisons showed a significant difference between luminal and TN (p < 0.0001), whereas the differences between luminal and TP (p = 0.115) and HER2 (p = 0.077) were not statistically significant. The 317 patients with involved SLN prior to NAT received SLNB and axillary dissection after completion of NAT. The analysis after NAT showed trends for lower rates of involved lymph nodes for the high-risk groups (TN 20% / TP 14.3% / HER2 8.7%) compared to luminal tumors (27.6%) without reaching statistical significance. Conclusions: Our analysis demonstrates that among patients enrolled in the SENTINA trial, patients with triple negative disease have the lowest risk for occult lymph node metastases at initial presentation. Our results do not justify more intense local intervention among patients with triple negative breast cancer.

Are Breast Cancer Nomograms Still Valid to Predict the Need for Axillary Dissection?

Oncology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Vilma Madekivi ◽  
Antti Karlsson ◽  
Pia Boström ◽  
Eeva Salminen
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Axillary Dissection ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Axillary Lymph Node Metastases ◽  
Node Negative ◽  
Node Metastases ◽  
External Population

Background: Nomograms can help in estimating the nodal status among clinically node-negative patients. Yet their validity in external cohorts over time is unknown. If the nodal stage can be estimated preoperatively, the need for axillary dissection can be decided. Objectives: The aim of this study was to validate three existing nomograms predicting 4 or more axillary lymph node metastases. Method: The risk for ≥4 lymph node metastases was calculated for n = 529 eligible breast cancer patients using the nomograms of Chagpar et al. [Ann Surg Oncol. 2007;14:670–7], Katz et al. [J Clin Oncol. 2008;26(13):2093–8], and Meretoja et al. [Breast Cancer Res Treat. 2013;138(3):817–27]. Discrimination and calibration were calculated for each nomogram to determine their validity. Results: In this cohort, the AUC values for the Chagpar, Katz, and Meretoja models were 0.79 (95% CI 0.74–0.83), 0.87 (95% CI 0.83–0.91), and 0.82 (95% CI 0.76–0.86), respectively, showing good discrimination between patients with and without high nodal burdens. Conclusion: This study presents support for the use of older breast cancer nomograms and confirms their current validity in an external population.

scholarly journals Predictors of axillary lymph node metastases in early breast cancer and their applicability in clinical practice

The Breast ◽  
2013 ◽  
Vol 22 (3) ◽  
pp. 357-361 ◽  
Author(s):  
Emi Yoshihara ◽  
Ann Smeets ◽  
Annouchka Laenen ◽  
Anneleen Reynders ◽  
Julie Soens ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Clinical Practice ◽  
Early Breast Cancer ◽  
Lymph Node Metastases ◽  
Axillary Lymph Node ◽  
Axillary Lymph ◽  
Axillary Lymph Node Metastases ◽  
Node Metastases

scholarly journals Sentinel Lymph Node Biopsy May Prevent Unnecessary Axillary Dissection in Patients with Inflammatory Breast Cancer Who Respond to Systemic Treatment

Breast Care ◽  
2020 ◽  
Vol 16 (5) ◽  
pp. 468-474
Author(s):  
Hasan Karanlik ◽  
Neslihan Cabioglu ◽  
Adela Luciana Oprea ◽  
Ilker Ozgur ◽  
Naziye Ak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Axillary Dissection ◽  
Triple Negative ◽  
Systemic Treatment ◽  
Lymph Node Biopsy ◽  
Her2 Positive ◽  
Node Biopsy

Background and Objectives: Inflammatory breast cancer (IBC) is a rare and aggressive breast cancer treated up-front with systemic treatment. Both breast-conserving surgery and sentinel lymph node biopsy (SLNB) are controversial issues in the management of IBC. In this study, we aimed to assess the feasibility of SLNB in pathologically proven node-positive IBC patients. Methods: All patients with a histopathological diagnosis of IBC and biopsy-proven metastatic axillary lymph nodes underwent systemic treatment. Patients with a complete clinical response in the axilla who underwent SLNB followed by standard axillary dissection were analyzed. Results: The study consisted of 25 female patients. The identification rate (IR) and the false negativity rate (FNR) were 17/25 and 2/10, respectively. Overall, 9/25 and 7/25 of patients had a complete pathological response (pCR) in the breast and axilla after systemic treatment, respectively. Although the pCR in the axilla was 2/4 in nonluminal HER2-positive patients, the highest IR 4/4 and the lowest FNR 0/2 were determined in these patients. In triple-negative patients, however, the IR was 2/4 and the FNR was found to be 0/2. Conclusions: SLNB may be considered in selected axilla-downstaged IBC patients including patients with a pCR with HER2-positive and triple-negative tumors. Axillary dissection may be, therefore, omitted in those with negative SLNs.

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