Improved False-Negative Rates with Intraoperative Identification of Clipped Nodes in Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy

Cabıoğlu, Neslihan; Karanlık, Hasan; Kangal, Dilek; Özkurt, Enver; Öner, Gizem; Sezen, Fatma; Yılmaz, Ravza; Tükenmez, Mustafa; Önder, Semen; İğci, Abdullah; Özmen, Vahit; Dinççağ, Ahmet; Engin, Gülgün; Müslümanoğlu, Mahmut

doi:10.1245/s10434-018-6575-6

Cited by 38 publications

(29 citation statements)

References 18 publications

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“…The FNR observed in cN1 patients was 4.2% when the clipped node was recognized as SLN, increasing to 16.7% if the removed clipped node did not correspond to the SLN. It concluded the validity of omission of ALND in patients whose nodes are clinically positive patients before NAC, become subsequently negative, if the negative clipped node is identified as SLN [41] .…”

Section: Neoajuvant Chemotherapymentioning

confidence: 97%

Axillary surgery in breast cancer: An updated historical perspective

Magnoni

Galimberti

Corso

et al. 2020

Seminars in Oncology

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This historical surgical retrospection focuses on the temporal de-escalation axillary surgery, focusing on the unceasing effort s of researchers toward new challenges, as documented by extensive studies and trials. Axillary surgery has evolved, aiming to offer the best oncologic treatment and improve the quality of life of women. Axillary lymph-node dissection (ALND) has been replaced by sentinel lymphnode biopsy (SLNB) in women with early clinically node-negative breast cancer, providing adequate axillary nodal staging information with minimal morbidity, and becoming the standard of care in the management of breast cancer. However, this is only the beginning. Strategies in defining systemic and radiotherapeutic treatments have gradually been optimized, offering increasingly refined and targeted breast cancer treatment tools. In recent years, the paradigm of completion ALND after a positive SLNB has been questioned, and several studies have led to revolutionary changes in clinical practice. Moreover, the increasingly pivotal role played by neoadjuvant chemotherapy (NAC) has had a profound effect on the extent of axillary surgery, paving the way to a more finite "targeted" procedure in women with node-positive breast cancer who convert to negative nodes clinically after NAC. The utility of SLNB itself and its subsequent omission in women with negative nodes clinically and breast conservative surgery is also under scientific evaluation. The changes over time in the surgical approach to breast cancer have been numerous and significant. The novel emerging perspective characterized by recent advances in biology and genetics, in dedicated axillary ultrasound imaging and chemotherapy regimens, is the present reality that points to the future of axillary node treatment in breast cancer.

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Section: Neoajuvant Chemotherapymentioning

confidence: 97%

Axillary surgery in breast cancer: An updated historical perspective

Magnoni

Galimberti

Corso

et al. 2020

Seminars in Oncology

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show abstract

“…Morency et al [ 15 ] reported that post-NAC axillary US was not appropriate as a standalone staging procedure in patients who present with N+ breast cancer. Previous studies emphasizing the importance of pre-NAC marking reported that the correct nodes were easily identifiable by US and other methods if metastatic nodes were properly marked before NAC [ 8 11 12 13 16 17 ]. These procedures should be done by an experienced breast-dedicated radiologist who identifies clipped nodes with a high success rate.…”

Section: Discussionmentioning

confidence: 99%

Targeted axillary biopsy and sentinel lymph node biopsy for axillary restaging after neoadjuvant chemotherapy

et al. 2021

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Purpose Accurate restaging of the axilla after neoadjuvant chemotherapy (NAC) is an important issue to ensure deescalating axillary surgery in patients with initial metastatic nodes. We aimed to present our results of targeted axillary biopsy (TAB) combined with sentinel lymph node biopsy (SLNB) for axillary restaging after NAC. Methods In 64 breast cancer patients who underwent NAC, biopsy-proven positive nodes were marked with clips before NAC, and ultrasound-guided wire localization of clip-marked nodes was performed after NAC. Patients underwent TAB and SLNB for post-NAC axilla restaging. Results Identification rates of post-NAC TAB and SLNB were 98.4% and 87.5%, respectively (P = 0.033). Histopathology revealed a nodal pathologic complete response (pCR) rate of 47% in which axillary lymph node dissection (ALND) was avoided. TAB alone and SLNB alone detected residual disease in 29 (85.3%) and 20 (58.8%) patients (P = 0.029), respectively. Whereas rates of up to 97% had been achieved with a combination of TAB and SLNB. The pCR rates after NAC were 64.3% for human epidermal growth factor receptor 2 positive and triple-negative tumors and 13.6% in luminal tumors (P = 0.0002). Conclusion Pathologic analysis following TAB combined with SLNB revealed the pCR rates to NAC in a considerable number of patients that provided de-escalation of axillary surgery. A combination of SLNB and TAB was found to be an accurate procedure in establishing residual nodal disease. This combined procedure in patients with initially positive nodes was a reliable method for post-NAC axillary restaging.

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“…However, SNB has been subsequently proven to be more accurate in cN1 patients who undergo NAC if - two or more nodes are removed, the clipped node is removed and immunohistochemistry is used. As a result, patients undergoing NAC can be down-staged in the axilla and ALND can potentially be avoided [ [43] , [44] , [45] ]. The same could be said for patients with pOBC, particularly if they are already considered to be in a better prognostic group than those patients with T1N1 disease [ 25 , 26 ].…”

Section: Diagnostic Techniques and Their Effect On The Incidence And mentioning

confidence: 99%

Occult breast cancer: Where are we at?

Ofri¹,

Moore

2020

The Breast

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Occult breast cancer (OBC) is described as an axillary metastatic carcinoma without detection of a primary breast lesion and is uncommon. Significant advances in breast imaging have occurred since its description, decreasing its incidence. However current management is based upon old studies, with variable clinical, radiological and pathological definitions of OBC. We suggest standardised definitions of OBC to facilitate more homogenous data representation in the literature. This review also discusses the conflicting heterogeneous data and its influence in determining the current management guidelines. We discuss whether the current significant surgical recommendations are necessary and postulate whether they could be safely substituted with less invasive management.

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Improved False-Negative Rates with Intraoperative Identification of Clipped Nodes in Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy

Abstract: The study results also suggest that axillary dissection could be omitted for patients presenting initially with N1 disease and with a negative clipped node as the SLN after NAC due to the low FNR.

Cited by 38 publications

References 18 publications

Axillary surgery in breast cancer: An updated historical perspective

Axillary surgery in breast cancer: An updated historical perspective

Targeted axillary biopsy and sentinel lymph node biopsy for axillary restaging after neoadjuvant chemotherapy

Occult breast cancer: Where are we at?

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