Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with node-positive breast cancer: guiding a more selective axillary approach

Purpose The role of sentinel lymph node biopsy (SLNB) in breast cancer patients who undergo neoadjuvant chemotherapy (NAC) remains controversial. This study aims to investigate if axillary lymph node dissection (ALND) could be safely omitted after a negative SLNB in cN1/2 patients who become cN0 aft...

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Bibliographic Details
Published in:Breast cancer research and treatment 2021-04, Vol.186 (2), p.527-534
Main Authors: Damin, Andrea P., Zancan, Maira, Melo, Marcia P., Biazus, Jorge V.
Format: Article
Language:English
Subjects:
Adjuvant treatment
Analysis
Biopsy
Breast cancer
Cancer
Cancer patients
Cancer research
Care and treatment
Chemotherapy
Disease control
Epidemiology
Lymph nodes
Lymphatic system
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Metastases
Metastasis
Oncology
Survival
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Summary:Purpose The role of sentinel lymph node biopsy (SLNB) in breast cancer patients who undergo neoadjuvant chemotherapy (NAC) remains controversial. This study aims to investigate if axillary lymph node dissection (ALND) could be safely omitted after a negative SLNB in cN1/2 patients who become cN0 after NAC. Methods We retrospectively assessed T1–4, cN1/2 patients who were submitted to NAC between 2010 and 2016. T1–T3 patients who achieved complete axillary clinical response underwent SLNB. Those whose SLNs were negative were not subjected to additional ALND. The oncological outcomes of the patients were analyzed. Results Fifty-nine T1–T3 patients (45.0%) achieved a complete axillary response (cN0), and were selected to undergo SLNB. SLNs were detected in 55 of them (93.2%). Seventeen of those patients (30.9%) had SLN metastases detected and subsequently underwent ALND. In contrast, 38 patients (69.1%) had no nodal metastases detected and were managed without complementary ALND. After a mean follow-up of 55.8 months, only one patient (2.6%) submitted to SLNB without a complementary ALND had axillary recurrence as compared with three patients (3.2%) in the ALND group ( p  = 0.71). Distant recurrence occurred more frequently among patients submitted to ALND (92.1%) than among those only submitted to SLNB (7.9%) ( p  
ISSN:0167-6806
1573-7217
DOI:10.1007/s10549-020-06011-8