Abstract
Background
Sentinel lymph node (SLN) dissection has been investigated after neoadjuvant chemotherapy and has shown mixed results. Our objective was to evaluate SLN dissection in node-positive patients and to determine whether postchemotherapy ultrasound could select patients for this technique.
Methods
Between 1994 and 2010, 150 patients with biopsy proven axillary metastasis underwent SLN dissection after chemotherapy and 121 underwent axillary lymph node dissection (ALND). Clinicopathologic characteristics were analyzed before and after chemotherapy. Statistical analyses included Fisher’s exact test for nodal response and multivariate logistic regression for factors associated with false-negative events.
Results
Median age was 52 years. Median tumor size at presentation was 2 cm. The SLN was identified in 93 % (139/150). In 111 patients in whom a SLN was identified and ALND performed, 15 patients had a false-negative SLN (20.8 %). In the 52 patients with normalized nodes on ultrasound, the false-negative rate decreased to 16.1 %. Multivariate analysis revealed smaller initial tumor size and fewer SLNs removed (<2) were associated with a false-negative SLN. There were 63 (42 %) patients with a pathologic complete response (pCR) in the nodes. Of those with normalized nodes on ultrasound, 38 (51 %) of 75 had a pCR. Only 25 (33 %) of 75 with persistent suspicious/malignant-appearing nodes had a pCR (p = 0.047).
Conclusions
Approximately 42 % of patients have a pCR in the nodes after chemotherapy. Normalized morphology on ultrasound correlates with a higher pCR rate. SLN dissection in these patients is associated with a false-negative rate of 20.8 %. Removing fewer than two SLNs is associated with a higher false-negative rate.
Similar content being viewed by others
References
Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8; discussion 398–401.
Cox CE, Bass SS, Ku NN, et al. Sentinel lymphadenectomy: a safe answer to less axillary surgery? Recent Results Cancer Res. 1998;152:170–9.
Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol. 2000;18:3480–6.
Schwartz GF, Giuliano AE, Veronesi U. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, Pennsylvania. Cancer. 2002; 94:2542–51.
Krishnamurthy S, Sneige N, Bedi DG, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer. 2002;95:982–8.
Buchholz TA, Hunt KK, Whitman GJ, et al. Neoadjuvant chemotherapy for breast carcinoma: multidisciplinary considerations of benefits and risks. Cancer. 2003;98:1150–60.
Hunt KK, Yi M, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients. Ann Surg. 2009;250:558–66.
Schwartz GF, Tannebaum JE, Jernigan AM, et al. Axillary sentinel lymph node biopsy after neoadjuvant chemotherapy for carcinoma of the breast. Cancer. 2010;116:1243–51.
Julian TB, Patel N, Dusi D, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer. Am J Surg. 2001;182:407–10.
Brady EW. Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer. Breast J. 2002;8:97–100.
Mamounas EP. NSABP Protocol B-27. Preoperative doxorubicin plus cyclophosphamide followed by preoperative or postoperative docetaxel. Oncology (Williston Park). 1997;11:37–40.
Classe JM, Bordes V, Campion L, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer: results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study. J Clin Oncol. 2009;27:726–32.
Shen J, Gilcrease MZ, Babiera GV, et al. Feasibility and accuracy of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients with documented axillary metastases. Cancer. 2007;109:1255–63.
Kang E, Chung IY, Han SA, et al. Feasibility of sentinel lymph node biopsy in breast cancer patients with initial axillary lymph node metastasis after primary systemic therapy. J Breast Cancer. 2011;14:147–52.
Hidar S, Bibi M, Gharbi O, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy in inflammatory breast cancer. Int J Surg. 2009;7:272–5.
Brown AS, Hunt KK, Shen J, et al. Histologic changes associated with false-negative sentinel lymph nodes after preoperative chemotherapy in patients with confirmed lymph node-positive breast cancer before treatment. Cancer. 2010;116:2878–83.
Jones JL, Zabicki K, Christian RL, et al. A comparison of sentinel node biopsy before and after neoadjuvant chemotherapy: timing is important. Am J Surg. 2005;190:517–20.
Reitsamer R, Peintinger F, Rettenbacher L, et al. Sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy. J Surg Oncol. 2003;84:63–7.
Martin RC 2nd, Chagpar A, Scoggins CR, et al. Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg. 2005;241:1005–12; discussion 1012–5.
Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8:881–8.
Thomas S, Prakash A, Goyal V, et al. Evaluation of sentinel node biopsy in locally advanced breast cancer patients who become clinically node-negative after neoadjuvant chemotherapy: a preliminary study. Int J Breast Cancer. 2011;870263.
Ozmen V, Unal ES, Muslumanoglu ME, et al. Axillary sentinel node biopsy after neoadjuvant chemotherapy. Eur J Surg Oncol. 2010;36:23–9.
Mainiero MB, Cinelli CM, Koelliker SL, et al. Axillary ultrasound and fine-needle aspiration in the preoperative evaluation of the breast cancer patient: an algorithm based on tumor size and lymph node appearance. AJR Am J Roentgenol. 2010;195:1261–7.
Koelliker SL, Chung MA, Mainiero MB, et al. Axillary lymph nodes: US-guided fine-needle aspiration for initial staging of breast cancer–correlation with primary tumor size. Radiology. 2008;246:81–9.
Khan A, Sabel MS, Nees A, et al. Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel lymph node biopsy. Ann Surg Oncol. 2005;12:697–704.
Croshaw RL, Erb KM, Shapiro-Wright HM, et al. The need for axillary dissection in patients with positive axillary sentinel lymph nodes. Curr Oncol Rep. 2011;13:5–10.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alvarado, R., Yi, M., Le-Petross, H. et al. The Role for Sentinel Lymph Node Dissection after Neoadjuvant Chemotherapy in Patients who Present with Node-Positive Breast Cancer. Ann Surg Oncol 19, 3177–3184 (2012). https://doi.org/10.1245/s10434-012-2484-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-012-2484-2