Analysis of sentinel lymph node mapping with immediate pathologic review in patients receiving preoperative chemotherapy for breast carcinoma

Miller, Alexander; Thomason, Virginia E.; Yeh, I‐Tien; Alrahwan, Amin; Sharkey, Francis E.; Stauffer, Jay S.; Otto, Pamela M; McKay, Claire; Kahlenberg, Morton S.; Phillips, William T.; Cruz, Anatolio B.

doi:10.1007/bf02573061

Cited by 87 publications

(5 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overall success rates for sentinel node identification were 84.4% which were similar to results from other single institutional studies [19-26]. This study also concluded that these rates are comparable to those obtained from other multi-centric studies evaluating SLNB and suggested that SLNB is feasible and reliable following NACT.…”

Section: Discussionsupporting

confidence: 88%

Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer - a prospective study

et al. 2011

View full text Add to dashboard Cite

BackgroundSentinel lymph node biopsy (SLNB) is now considered a standard of care in early breast cancers with N0 axillae; however, its role in locally advanced breast cancer (LABC) after neo-adjuvant chemotherapy (NACT) is still being debated. The present study assessed the feasibility, efficacy and accuracy of sentinel lymph node biopsy (SLNB) using "dye alone" (methylene blue) method in patients with LABC following NACT.Materials and methodsThirty, biopsy proven cases of LABC that had received three cycles of neo-adjuvant chemotherapy (cyclophosphamide, adriamycin, 5-fluorouracil) were subjected to SLNB (using methylene blue dye) followed by complete axillary lymph node dissection (levels I-III). The sentinel node(s) was/were and the axilla were individually assessed histologically. The SLN accuracy parameters were calculated employing standard definitions. The SLN identification rate in the present study was 100%. The sensitivity of SLNB was 86.6% while the accuracy was 93.3%, which were comparable with other studies done using dual lymphatic mapping method. The SLN was found at level I in all cases and no untoward reaction to methylene blue dye was observed.ConclusionsThis study confirms that SLNB using methylene blue dye as a sole mapping agent is reasonably safe and almost as accurate as dual agent mapping method. It is likely that in the near future, SLNB may become the standard of care and provide a less morbid alternative to routine axillary lymph node dissection even in patients with LABC that have received NACT.

show abstract

Section: Discussionsupporting

confidence: 88%

Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer - a prospective study

et al. 2011

View full text Add to dashboard Cite

show abstract

“…In the initially node-negative subgroup, 3 studies used blue dye alone,[172032] 4 studies used radioisotope alone,[14152229] 15 studies used both blue dye and radioisotope,[31112131619212324252627283031] and 1 study did not state the type of the tracer used. [18] One study considered abnormal palpable LNs as SLNs.…”

Section: Resultsmentioning

confidence: 99%

“…[18] One study considered abnormal palpable LNs as SLNs. [32] Concerning pathologic assessment, 6 articles used hematoxylin and eosin (H & E) only,[151617212332] 10 articles used IHC for negative H & E samples,[11121314182022242526] 5 articles used both H & E and IHC,[319272830] 1 study used H & E, IHC, and one-step nucleic acid amplification (OSNA),[29] and 1 study did not state the type of the tracer used. [31] Importantly, 1 study considered micrometastasis (yp mi) as involved SLN[20] and 3 studies considered micrometastasis (yp mi) and isolated tumor cell (ITC) (yp i+) as positive SLN.…”

Section: Resultsmentioning

confidence: 99%

Assessment of sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer in two subgroups: Initially node negative and node positive converted to node negative – A systemic review and meta-analysis

2019

View full text Add to dashboard Cite

Background:Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients with breast cancer, but the reliability of sentinel lymph node biopsy (SLNB) following chemotherapy is in doubt. In this meta-analysis, we aimed to evaluate studies that examine the results of SLNB after NAC to assess identification rate (IR) and false-negative rate (FNR).Materials and Methods:Systemic searches were performed in the PubMed, ISI Web of Sciences, Scopus, and Cochrane databases from January 1, 2000, to November 30, 2016, for studies of SLNB after NAC for breast cancer and followed by axillary lymph node (LN) dissection in two subgroups: initially node negative and node positive converted to node negative. Two reviewers independently review quality of included studies. A random-effects model was used to pool IR and FNR with 95% confidence intervals (CI), and heterogeneity among studies was assessed by I2 and Q-test.Results:A total of 23 studies with 1521 patients in the initially node-negative subgroup and 13 studies with 1088 patients in the node-positive converted to node-negative subgroup, were included in this meta-analysis with IR and FNR of 94% (95% CI: 92–96) and 7% (95% CI: 5–9) in the initially node-negative subgroup and 89% (95% CI: 85–94) and 13% (95% CI: 7–18) in the node-positive converted to node-negative subgroup, respectively.Conclusion:Our meta-analysis showed acceptable IR and FNR in initially node-negative group and it seems feasible in these patients, but these parameters did not reach to predefined value in node-positive converted to node-negative group, and thus, it is not recommended in these patients.

show abstract

“…The SLN identification rate after neoadjuvant chemotherapy varied from 82% to 100% with an FNR of 0% to 39% according to several small, single‐center studies (Table 4) [3, 4, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]. Mamounas [14] reported the results of SLNB for 428 of a total of 2411 patients enrolled in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B‐27 neoadjuvant chemotherapy trial, where the identification rate was 85%, and the FNR was 11%.…”

Section: Discussionmentioning

confidence: 99%

Decreased Identification Rate of Sentinel Lymph Node after Neoadjuvant Chemotherapy

et al. 2004

View full text Add to dashboard Cite

We prospectively studied the feasibility of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy by comparing the identification rate and the false-negative rate (FNR) with the results obtained from the patients without chemotherapy. From October 2001 to March 2003, a total of 284 consecutive patients who underwent SLNB and axillary lymph node dissection (ALND) at the Center for Breast Cancer, National Cancer Center were enrolled. Of the 284 patients, 54 underwent neoadjuvant chemotherapy prior to operation. The sentinel lymph node (SLN) was mapped by radioactive colloid alone or in combination with blue dye. All SLNs were evaluated by 2 mm serial sections after hematoxylin-eosin staining. The overall SLN identification rate was 91.9% (261/284): 72.2% (39/54) of the patients after chemotherapy and 96.5% (222/230) of the patients without chemotherapy. These results suggest that preoperative chemotherapy significantly affects lymphatic mapping ( p< 0.001). Among the patients with chemotherapy, there were 3 false negatives in 39 successfully mapped tumors, yielding an FNR of 11.1% (3/27), a negative prediction value (NPV) of 80.0% (12/15), and an accuracy of 92.3% (36/39). There were 10 false negatives among 222 successfully detected patients without chemotherapy, yielding an FNR of 9.9% (10/101), an NPV of 92.4% (121/131), and an accuracy of 95.5% (212/222). These results were not statistically different when compared ( p > 0.05). Although the SLN identification rate significantly decreased after neoadjuvant chemotherapy, SLNB could accurately predict axillary status. Thus SLNB can be an alternative to ALND even after neoadjuvant chemotherapy in cases of successful identification of the SLN.

show abstract

Analysis of sentinel lymph node mapping with immediate pathologic review in patients receiving preoperative chemotherapy for breast carcinoma

Abstract: These results demonstrate that SLNM can be consistently performed in patients receiving preoperative chemotherapy for breast cancer, suggesting the utility of this technique in this patient population.

Cited by 87 publications

References 31 publications

Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer - a prospective study

Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer - a prospective study

Assessment of sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer in two subgroups: Initially node negative and node positive converted to node negative – A systemic review and meta-analysis

Decreased Identification Rate of Sentinel Lymph Node after Neoadjuvant Chemotherapy

Contact Info

Product

Resources

About