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Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer

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Abstract

Background

After neoadjuvant chemotherapy, women with locally advanced breast cancer (LABC) undergo a modified radical mastectomy or lumpectomy with axillary lymph node dissection (ALND) and radiotherapy. Sentinel lymphadenectomy (SL) is accepted for axillary evaluation in early breast cancer. We assessed the feasibility and predictive value of SL after neoadjuvant chemotherapy.

Methods

Eligible women received neoadjuvant therapy for LABC and were scheduled to undergo a definitive surgical procedure. Vital blue dye SL was attempted followed by level I and II axillary dissection.

Results

SL was successful in 29 of 34 patients (detection rate, 85%). Thirteen patients (45%) had positive nodes, and eight (28%) had negative nodes on both SL and ALND. In five patients (17%), the sentinel node was the only positive node identified. Overall, there was a 90% concordance between SL and ALND. The false-negative rate and negative predictive value were 14% and 73%, respectively. Among the subgroup without inflammatory cancer, the detection and concordance rates were 89% and 96%, respectively. The false-negative rate was 6%, and the negative predictive value was 88%.

Conclusions

SL after neoadjuvant chemotherapy may reliably predict axillary staging except in inflammatory breast cancer. Further studies are required to assess the utility of SL as the only mode of axillary evaluation in these women.

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Authors and Affiliations

  1. Breast Cancer Program, Department of Oncology, Lombardi Cancer Center, Georgetown University School of Medicine, Washington, DC

    Vered Stearns MD, Rebecca Slack MS & Daniel F. Hayes MD

  2. Department of Pathology, Lombardi Cancer Center, Georgetown University School of Medicine, Washington, DC

    C. Alexander Ewing MD

  3. Biostatistics Unit, Lombardi Cancer Center, Georgetown University School of Medicine, Washington, DC

    Rebecca Slack MS

  4. Department of Surgery, Lombardi Cancer Center, Georgetown University School of Medicine, Washington, DC

    Marie F. Penannen MD & Theodore N. Tsangaris MD

Authors
  1. Vered Stearns MD
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  2. C. Alexander Ewing MD
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  3. Rebecca Slack MS
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  4. Marie F. Penannen MD
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  5. Daniel F. Hayes MD
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  6. Theodore N. Tsangaris MD
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Correspondence to Vered Stearns MD.

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Stearns, V., Ewing, C.A., Slack, R. et al. Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Annals of Surgical Oncology 9, 235–242 (2002). https://doi.org/10.1007/BF02573060

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  • DOI: https://doi.org/10.1007/BF02573060

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