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Sentinel lymph node biopsy alone after neoadjuvant chemotherapy in patients with initial cytology-proven axillary node metastasis.

Kim JY, Kim MK, Lee JE, Jung Y, Bae SY, Lee SK, Kil WH, Kim SW, Kim KS, Nam SJ, Han S - J Breast Cancer (2015)

Bottom Line: A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results.For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031).However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Purpose: Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis.

Methods: From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results.

Results: At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050).

Conclusion: SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival curves for axillary event-free survival in groups 1, 2, and 4 (3.3%, 5.0%, and 1.3%, log-rank test, p>0.05).
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Figure 3: Kaplan-Meier survival curves for axillary event-free survival in groups 1, 2, and 4 (3.3%, 5.0%, and 1.3%, log-rank test, p>0.05).

Mentions: During the study period, five of the 31 patients (16.1%) in the group 1 experienced two systemic and three regional recurrences. Table 4 summarizes the types of recurrences and clinical characteristics in this group. Further, in the SLNB alone group, two patients with HER2-positive tumors developed neurologic symptoms and were diagnosed with brain metastases within 6 months after surgery. Of the patients with recurrences in the SLNB alone group, axillary recurrence occurred in only one patient at 10 months postoperatively. The rate of axillary recurrence demonstrated no statistical differences among the groups (3.3%, 5.0%, and 1.3% for groups 1, 2, and 4, respectively, p>0.05). The rate of axillary recurrence was not significantly worse in the SLNB alone group in the axillary event-free survival analysis as shown in Figure 3.


Sentinel lymph node biopsy alone after neoadjuvant chemotherapy in patients with initial cytology-proven axillary node metastasis.

Kim JY, Kim MK, Lee JE, Jung Y, Bae SY, Lee SK, Kil WH, Kim SW, Kim KS, Nam SJ, Han S - J Breast Cancer (2015)

Kaplan-Meier survival curves for axillary event-free survival in groups 1, 2, and 4 (3.3%, 5.0%, and 1.3%, log-rank test, p>0.05).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4381119&req=5

Figure 3: Kaplan-Meier survival curves for axillary event-free survival in groups 1, 2, and 4 (3.3%, 5.0%, and 1.3%, log-rank test, p>0.05).
Mentions: During the study period, five of the 31 patients (16.1%) in the group 1 experienced two systemic and three regional recurrences. Table 4 summarizes the types of recurrences and clinical characteristics in this group. Further, in the SLNB alone group, two patients with HER2-positive tumors developed neurologic symptoms and were diagnosed with brain metastases within 6 months after surgery. Of the patients with recurrences in the SLNB alone group, axillary recurrence occurred in only one patient at 10 months postoperatively. The rate of axillary recurrence demonstrated no statistical differences among the groups (3.3%, 5.0%, and 1.3% for groups 1, 2, and 4, respectively, p>0.05). The rate of axillary recurrence was not significantly worse in the SLNB alone group in the axillary event-free survival analysis as shown in Figure 3.

Bottom Line: A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results.For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031).However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Purpose: Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis.

Methods: From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results.

Results: At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050).

Conclusion: SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection.

No MeSH data available.


Related in: MedlinePlus