Axillary lymph node recurrence following wire‐directed sentinel lymph node dissection for breast cancer patients with biopsy‐proven axillary metastases prior to neoadjuvant chemotherapy at a safety net medical center

Abstract

Background Although sentinel lymph node dissection (SLND) after neoadjuvant chemotherapy (NAC) is feasible, axillary management for patients with pretreatment biopsy‐proven axillary metastases and who are clinically node‐negative after NAC (ycN0) remains unclear. This retrospective study was performed to determine the rate of axillary lymph node recurrence for such patients who had wire‐directed (WD) SLND. Methods Patients treated with NAC from 2015 to 2020 had axillary nodes evaluated by pretreatment ultrasound. Core biopsies were done on abnormal nodes, and microclips were placed in nodes during biopsy. For patients with biopsy‐proven node metastases who received NAC and were ycN0 by clinical exam, WD SLND was done. Patients with negative nodes on frozen section had WD SLND alone; those with positive nodes had WD SLND plus axillary lymph node dissection (ALND). Results Of 179 patients receiving NAC, 62 were biopsy‐proven node‐positive pre‐NAC and ycN0 post‐NAC. Thirty‐five (56%) patients were node‐negative on frozen section and had WD SLND alone. Twenty‐seven (43%) patients had WD SLND + ALND. Forty‐seven patients had postoperative regional node irradiation. With median follow‐up of 40 months, there were recurrences in 4 (11%) of 35 patients having WD SLND and 5 (19%) of 27 having WD SLND + ALND, but there was only one axillary lymph node recurrence, identified by CT scan. Conclusions Axillary node recurrence was very uncommon after WD SLND for patients who had pretreatment biopsy‐proven node metastases and were ypN0 after NAC. These patients would be unlikely to derive clinical benefit from the addition of completion ALND to SLND.

What's new in surgical oncology breast

“…38,39 A retrospective study by Sargent et al was done to determine the rate of axillary lymph node recurrence for patients who had pretreatment biopsy-proven axillary lymph node metastases, were clinically node-negative (ycN0) after NAC and had wire-directed (WD) SLND. 40 The hypothesis was that patients rendered pathologically node-negative (ypN0) by NAC do not benefit from a completion ALND. Patients who were ypN0 on frozen section had WD SLND alone, while those who were lymph node-positive (ypN+) on frozen section had WD SLND followed by ALND.…”

Use of ultrasound and MRI to stage the axilla for breast cancer before and after neoadjuvant chemotherapy prior to targeted sentinel lymphadenectomy

“…It was demonstrated in a prior publication from this Center that for patients with pre-treatment biopsy-proven axillary metastases who were clinically node-negative (ycN0) post-neoadjuvant chemotherapy (NAC) and had a targeted wire-directed sentinel lymphadenectomy (WD-SLND), 60% were node negative on final pathology (ypN0) [ 1 ]. For these node-negative patients, completion axillary lymph node dissection (ALND) was not performed.…”