Can sentinel node biopsy after neoadjuvant systemic chemotherapy (NAC) be safely omitted in selected patient with early breast cancer?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 564-564
Author(s):  
Atsushi Yoshida ◽  
Yasuyuki Kojima ◽  
Mizuho Tazo ◽  
Naoko Matsuda ◽  
Koichiro Tsugawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
Cancer Patients ◽  
Primary Tumor ◽  
Primary Breast Cancer ◽  
Clinicopathological Factors ◽  
Breast Cancer Patients ◽  
Mri Findings ◽  
Ki 67 ◽  
Node Biopsy

564 Background: There is a recent trend of performing minimum axillary surgery considering the prognostic value and fewer complications for primary breast cancer patients since the results of ACOSOG Z011. Nodal status after NAC is not be useful for postoperative treatment in most of cN0 patients. Therefore, sentinel node biopsy (SNB) may be omitted if ypN0 after NAC can be predicted in cN0 patients. We assessed clinicopathological factors associated with ypN0 after NAC in cN0 primary breast cancer patients. Methods: Two-institutional retrospective cohort study of clinically N0 breast cancer patients before NAC and who underwent breast surgery was conducted, including 419 consecutive patients between 2009 and 2016 in St. Luke's International Hospital and St. Marianna University School of Medicine hospital. Each institutional review board approved this study. In the patients with or without nodal metastasis on SNB after NAC, we compared clinicopathological factors including Estrogen Receptor (ER), Progesterone Receptor (PgR), human epidermal growth factor receptor 2 (HER2), Ki-67 on needle biopsy specimens, and tumor size before and after NAC on MRI findings. Results: Of the 419 patients, 380 patients (90.7%) were ypN0 and 39 patients (9.3%) were ypN+ after NAC. In univariate analysis, clinical complete response of primary tumor on MRI findings (MRI-CR) (p<0.01), ER-negative (p<0.01), PgR-negative (p<0.01), and high-Ki-67 >30% (p<0.01) were significantly associated with ypN0 on SNB after NAC. In multivariate analysis, MRI-CR (HR 5.12, p<0.01) and high-Ki-67 (HR 2.86, p<0.01) were independent predictive factors of ypN0 after NAC.According to breast cancer subtype, only one of 72 ER-negative and HER2-positive had significantly low risk of ypN+ (1.3%) comparing other subtypes (p<0.01). Conclusions: Achieving cCR of primary tumor after NAC and high-Ki67 in cN0 patients, especially in HER2 type breast cancer, might have ypN0. We are conducting prospective study to omit SNB for these populations based on these results,

scholarly journals Sentinel Node Biopsy Guided by Indocyanin Green Dye in Breast Cancer Patients

1999 ◽  
Vol 29 (12) ◽  
pp. 604-607 ◽  
Author(s):  
K. Motomura ◽  
H. Inaji ◽  
Y. Komoike ◽  
T. Kasugai ◽  
S. Noguchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
Cancer Patients ◽  
Sentinel Node Biopsy ◽  
Breast Cancer Patients ◽  
Node Biopsy

scholarly journals Added value of blue dye injection in sentinel node biopsy of breast cancer patients: Do all patients need blue dye?

2014 ◽  
Vol 12 (4) ◽  
pp. 325-328 ◽  
Author(s):  
Ramin Sadeghi ◽  
Ghazaleh Alesheikh ◽  
Seyed Rasoul Zakavi ◽  
Asiehsadat Fattahi ◽  
Abbas Abdollahi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
Cancer Patients ◽  
Sentinel Node Biopsy ◽  
Added Value ◽  
Blue Dye ◽  
Breast Cancer Patients ◽  
Node Biopsy

scholarly journals Platelet-Rich Plasma (PRP) in Breast Cancer Patients: An Application Analysis of 163 Sentinel Lymph Node Biopsies

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
C. Eichler ◽  
C. Baucks ◽  
J. Üner ◽  
C. Pahmeyer ◽  
D. Ratiu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sentinel Node ◽  
Cancer Patients ◽  
Sentinel Node Biopsy ◽  
Platelet Rich Plasma ◽  
Distant Metastases ◽  
Complication Rates ◽  
Breast Cancer Patients ◽  
Node Biopsy

Introduction. Literature shows platelet-rich plasma (PRP) to improve overall outcomes in orthopedics, dermatology, ophthalmology, gynecology, and plastic surgery. Data on oncological patients is very limited. Only one publication is available on PRP in breast cancer patients. This work evaluated PRP in sentinel node biopsy procedures for breast cancer patients in terms of complication rates and oncological short-term follow-up. Methods. The evaluated PRP was ACP®, i.e., autologous conditioned plasma by Arthrex®. Between 2015 and 2018, 163 patients were offered to receive an ACP®/PRP injection in their lymph node biopsy site. Recruitment resulted in an approximate one-to-one ratio for analysis. Endpoints were major (revision) and minor (seroma, hematoma, and infection) complications rates as well as distant metastases, local recurrence, and overall survival. Median follow-up was 30 months. Results. Complication rates and oncological follow-up showed PRP to be applicable to use in a sentinel node biopsy scenario in breast cancer patients. There were 0 revisions in the ACP®/PRP group and 1.2% revisions in the control group (not significant). Oncological follow-up showed zero (0) distant metastases and local recurrences as well as a 100% 30-month overall survival. Conclusions. This is the first analysis of ACP®/PRP used in breast cancer patients in a sentinel node biopsy setting worldwide. PRP does not seem to increase rates of local recurrence within this 30-month follow-up time frame. Also, trend towards decreasing complication rates could be shown.

Clinical Significance of Subtype Classification in Metastatic Lymph Nodes of Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy

2015 ◽  
Vol 30 (2) ◽  
pp. 174-183 ◽  
Author(s):  
Noriko Nemoto ◽  
Yukiko Shibahara ◽  
Hiroshi Tada ◽  
Keiko Uchida ◽  
Keely M. McNamara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Primary Tumor ◽  
Breast Cancer Patients ◽  
Ki 67 ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph

Background Neoadjuvant chemotherapy has been increasingly utilized in the treatment of breast cancer patients. However, there are no established surrogate markers predicting the response to subsequent adjuvant therapy and clinical outcome of patients. In particular, whether primary or lymph nodes metastasis should be evaluated for these analyses has remained unknown. Therefore, in this study, we first evaluated the differences in biomarkers between primary and metastatic cancer tissues in the patients undergoing neoadjuvant chemotherapy. We then correlated the findings with the clinical outcomes of these patients. Methods We examined 49 patients receiving neoadjuvant chemotherapy and subsequent surgery with lymph node metastasis. Estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2) and Ki-67 were all immunohistochemically evaluated in core needle biopsy samples from primary and metastatic tumors following chemotherapy. Results No statistically significant differences in these markers were detected between the primary tumor and metastatic lymph nodes following therapy, but the Ki-67 labeling index was significantly higher in metastatic lymph nodes than in primary tumor (p = 0.017). The patients associated with luminal A type carcinoma in their lymph nodes following chemotherapy demonstrated significantly better clinical outcomes (disease-free survival: p = 0.0045, overall survival: p = 0.0006) than those who were not. Conclusion These data indicate that subtype classification following chemotherapy, in the metastatic lymph nodes rather than primary tumor could predict long-term outcomes of patients undergoing neoadjuvant chemotherapy.

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