Sentinel lymph node biopsy in patients with operable breast cancer treated with neoadjuvant chemotherapy

• Published in: Revista Española de medicina nuclear e imagen molecular (English ed.) 2012-05, Vol.31 (3), p.117-123
• Main Authors: Rebollo-Aguirre, Á.C, Gallego-Peinado, M, Menjón-Beltrán, S, García-García, J, Pastor-Pons, E, Chamorro-Santos, C.E, Ramos-Font, C, Salamanca-Ballesteros, A, Llamas-Elvira, J.M, Olea-Serrano, N
• Format: Article
• Language: English
• Subjects: Breast cancer; Cáncer de mama; Ganglio centinela; Neoadjuvant chemotherapy; Primary systemic therapy; Quimioterapia neoadyuvante; Radiology; Sentinel lymph node; Terapia sistémica primaria
• ISSN: 2253-8089; 2253-8089
• DOI: 10.1016/j.remnie.2012.05.001

Abstract Aim To evaluate the accuracy of sentinel lymph node biopsy (SLNB) in operable breast cancer patients treated with neoadjuvant chemotherapy (NAC). Material and methods Between January 2008 and 2011, 88 women, mean age 49.4 years, with infiltrating breast carcinoma, were studied prospectively. Patients were T1–3, N0–1, M0. Prior to surgery, the patients received chemotherapy (epirubicin/cyclophosphamide, docetaxel), and trastuzumab in Her2/neu-positive patients. Axillary status was established by physical examination, ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74–111 MBq of99m Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB, followed by complete axillary lymph node dissection (ALND). Sentinel lymph node (SLN) was examined by frozen sections, hematoxylin–eosin staining and immunohistochemical analysis or One Step Nucleic Acid Amplification (OSNA). Results Mean tumor size: 3.5 cm, histologic type: 69 invasive ductal, 16 invasive lobular and 3 others. Thirty-seven patients had clinical/ultrasound node-positive at presentation. Clinical response of primary tumor to NAC: complete in 38, partial in 45, and stable disease in 5 patients. A pathological complete response was achieved in 25. All patients were clinically node-negative after NAC. SLN identification rate was 92.0%. Six of 7 patients in whom SLN was not found had clinical/ultrasound positive axilla before NAC. SLN accurately determined the axillary status in 96.5%. False negative rate was 8.3%. In 69.4% of patients, SLN was the only positive node. The mean number of SLN removed was 1.7 and nodes resected from the ALND were 13.2. Conclusion SLN biopsy after NAC can predict the axillary status with a high accuracy in patients with breast cancer, avoiding unnecessary ALND.