Sentinel node biopsy after neoadjuvant treatment in breast cancer: Five-year follow-up of patients with clinically node-negative or node-positive disease before treatment. Issue 3 (March 2016)

• Record Type: Journal Article
• Authors: Galimberti, V.; Ribeiro Fontana, S.K.; Maisonneuve, P.; Steccanella, F.; Vento, A.R.; Intra, M.; Naninato, P.; Caldarella, P.; Iorfida, M.; Colleoni, M.; Viale, G.; Grana, C.M.; Rotmensz, N.; Luini, A.
• Is Part Of: European journal of surgical oncology. Volume 42:Issue 3(2016:Mar.)
• Page Start: 361
• Page End: 368
• Publication Date: 2016-03
• Subjects: Neoadjuvant treatment -- Sentinel node biopsy -- Primary breast cancer -- Axillary dissection; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2015.11.019
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Purpose: It is controversial whether sentinel node biopsy (SNB) without axillary dissection (AD) should be performed in cN1/2 breast cancer patients who become cN0 after neoadjuvant treatment, since the false negative rate (FNR) may be unacceptably high. We assessed outcomes to address this issue. Methods: We retrospectively assessed 396 cT1-4, cN0/1/2 patients, who became or remained cN0 after neoadjuvant treatment and underwent SNB with at least one sentinel node (SN) found, and AD not performed if the SN was negative. Results: After a median follow-up of 61 months (interquartile range 38–82), five-year overall survival was 90.7% (95%CI, 87.7–93.7) in the whole cohort, 93.3% (95%CI, 90.0–96.6) in those initially cN0, and 86.3% (95%CI, 80.6–92.1) in those initially cN1/2 ( P = 0.12). Axillary failure occurred in only 1 (0.7%) initially cN1/2 patient who became cN0. In initially cN0 patients, and also initially cN1/2 patients who responded well to neoadjuvant treatment (ypT0/ypTx), SN-negativity was a significant predictor of good outcome, consistent with the known prognostic significance of axillary status, and suggesting that SN status accurately reflected axillary status. By contrast, in initially cN1/2 patients found to be ypT1/2/3, SN status (and whether or not AD was performed) had no influence on survival. Conclusions: These findings suggest that SNB is acceptable in cN1/2 patients who become cN0 after neoadjuvant therapy.