Comparison of Survival Outcomes for Axillary Surgery Extent Based on Intraoperative Sentinel Lymph Node Biopsy Result After Neoadjuvant Chemotherapy for Breast Cancer

2021 ◽  
Author(s):  
Jung Whan Chun ◽  
Jisun Kim ◽  
Il Yong Chung ◽  
Beom Seok Ko ◽  
Hee Jeong Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Axillary Recurrence ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Axillary Surgery ◽  
Distant Metastasis Free Survival

Abstract PurposeTo investigate the survival difference between limited axillary surgery and full axillary lymph node dissection (ALND) in patients with 1-3 positive sentinel lymph node biopsies (SLNBs) after neoadjuvant chemotherapy (NAC).MethodWe retrospectively analyzed data from 676 patients who underwent surgery between 2007 and 2017 with cT1-4, cN0-3, cM0 breast cancer at the time of diagnosis and 1-3 positive SLNBs after NAC. The patients received either SLNB only or completed level I or II ALND based on SLNB results. After propensity score matching, 483 patients who had undergone SLNB only (n=188) and ALND (n=295) were included. We examined overall survival, axillary recurrence-free survival, regional recurrence-free survival, and distant metastasis-free survival and compared them between the subgroups.ResultAt a median follow-up of 59.4 months, no significant statistical difference was observed in overall survival, axillary recurrence-free survival, regional recurrence-free survival, and distant metastasis-free survival between SLNB only and ALND. No significant differences were observed in the 5-year axillary recurrence-free survival (93.1% vs. 94.0%, hazard ratio [HR]=0.94, 95% confidence interval [CI]=0.43-2.05, p=0.876) and 5-year overall survival (97.7% vs. 97.3%, HR=1.65, 95% CI=0.58-4.65, p=0.347) between the two groups.ConclusionOur analysis suggests that SLNB alone may be a possible option for patients with 1-3 sentinel node-positive breast cancer following NAC without significant compromise of recurrence or overall survival.

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.

Greater negative lymph node count predicts favorable survival of patients with breast cancer in the setting of neoadjuvant chemotherapy and mastectomy

2019 ◽  
Vol 15 (32) ◽  
pp. 3701-3709 ◽  
Author(s):  
Xin Wang ◽  
Zhenzhen Yin ◽  
Daquan Wang ◽  
Jiaqi Zhang ◽  
Shuai Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Malignant Tumors ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Free Survival ◽  
Lymph Node Count ◽  
Disease Free

Aim: Adequate lymph node evaluation is recommended in patients with malignant tumors. However, the role of negative lymph nodes (NLNs) remains unclear in breast cancer (BC), especially in patients who have received neoadjuvant chemotherapy and mastectomy. Materials & methods: A total of 435 patients were included in the analysis. On multivariate analysis, NLN count was an independent predictor of 5 year disease-free survival and 5 year overall survival. Results: Patients with NLN count <10 showed significantly worse 5 year disease-free survival than those with NLN count ≥10 (34.8 and 78.2%; p = 0.000); the corresponding 5 year overall survival rates were also significantly different (52.0 and 82.7%; p = 0.000). Conclusion: This is the first study that confirms the relationship between NLN count and prognosis of patients in the setting of neoadjuvant chemotherapy and mastectomy. More NLNs imply better prognosis.

Early Breast Cancer - Less Axillary Surgery?

Swiss Surgery ◽  
2000 ◽  
Vol 6 (3) ◽  
pp. 116-120 ◽  
Author(s):  
Gambazzi ◽  
Zuber ◽  
Oertli ◽  
Marti ◽  
Kocher ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Breast Cancer ◽  
Axillary Surgery ◽  
Kaplan Meier

Kleine Mammakarzinome werden häufiger entdeckt. Die nodal positiven Fälle werden seltener. Die sentinel lymph node (SLN) Technik könnte die geeignete Methode sein, unnötige Axilladissektionen zu vermeiden. Wir untersuchten ein Kollektiv von Patientinnen mit pT1 Tumoren in Bezug auf Nodalstatus (pT1a,b und c), auf Axillarezidiv sowie auf das Gesamtüberleben. Von 1983 bis 1997 wurden konsekutiv 185 Frauen mit einem Mammakarzinom </= 20mm Durchmesser behandelt. Die Überlebensdaten nach Kaplan-Meier stützten sich auf eine Kohorte aus 117 Patientinnen mit einer medianen Nachsorge von mindestens sieben Jahren. Es fanden sich sieben Patientinnen mit einem pT1a Karzinom, 30 mit einem pT1b Karzinom und 148 mit einem pT1c Karzinom. Im Mittel wurden 16 axilläre Lymphknoten vom Pathologen gezählt. Der axilläre Lymphknotenbefall zeigte eine erwartete Abhängigkeit von der Tumorgrösse: Kein Axillabefall bei nur sieben pT1a, 10% befallene Lymphknoten bei pT1b und 30% bei pT1c Karzinomen. Kein einziges Axillarezidiv wurde während der Beobachtungszeit entdeckt. Das Gesamtüberleben nach zehn Jahren betrug für Patientinnen mit einem pT1a Karzinom 100%, 91% für pT1b und noch 74% für pT1c Karzinome. Die Screening Mammographie entdeckt vermehrt kleinere Mammakarzinome. Die pN+ Stadien nehmen ab. Hier müssen Nutzen und Risiko der Axilladissektion einander kritisch gegenübergestellt werden. Eine selektive Axilladissektion ermöglicht die sentinel lymph node (SLN) Methode, welche in Verbindung mit aufwendigeren histologischen Nachweismethoden den axillären Nodalstatus realistisch wiedergibt.

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