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.

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.

• Authors: V Galimberti, S K Ribeiro Fontana, P Maisonneuve, F Steccanella, A R Vento, M Intra, P Naninato, P Caldarella, M Iorfida, M Colleoni, G Viale, C M Grana, N Rotmensz, A Luini
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 42 Issue 3 Pg. 361-8 (Mar 2016) ISSN: 1532-2157 [Electronic] England
• PMID: 26746091 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.

Topics

• Adult
• Aged
• Axilla (surgery)
• Breast Neoplasms (mortality, pathology, therapy)
• Databases, Factual
• Disease-Free Survival
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Lymph Node Excision (methods)
• Lymph Nodes (pathology, surgery)
• Mastectomy, Segmental (methods)
• Middle Aged
• Multivariate Analysis
• Neoadjuvant Therapy (methods)
• Neoplasm Invasiveness (pathology)
• Neoplasm Staging
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Sentinel Lymph Node Biopsy (methods)
• Survival Analysis
• Time Factors