Long-term standard sentinel node biopsy after neoadjuvant treatment in breast cancer: a single institution ten-year follow-up

Fontana, Sabrina Kahler Ribeiro; Pagan, Eleonora; Magnoni, Francesca; Vicini, Elisa; Morigi, Consuelo; Corso, Giovanni; Intra, Mattia; Canegallo, Fiorella; Ratini, Silvia; Leonardi, Maria Cristina; Rocca, Eliana La; Bagnardi, Vincenzo; Montagna, Emilia; Colleoni, Marco; Viale, Giuseppe; Bottiglieri, Luca; Grana, Chiara Maria; Biasuz, Jorge Villanova; Veronesi, Giulia; Galimberti, Viviana

doi:10.1016/j.ejso.2020.10.014

Cited by 103 publications

(74 citation statements)

References 41 publications

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“…In recent years, SLNB has also become standard of care for patients with clinically unsuspicious nodes at time of diagnosis who have completed neoadjuvant chemotherapy. The detection rate and accuracy of SLNB are excellent in this setting, and axillary recurrence rates are negligible [1][2][3].…”

Section: Introductionmentioning

confidence: 85%

“…2 The clip was absent on postoperative axillary radiography in the remaining five patients, suggesting clip dislodgement. 3 Lymph nodes with isolated tumor cells were considered positive. 4 In the remaining 17% of patients, the clip was neither in the SLN nor in the ALND specimen.…”

Section: Which Marking Technique Is Optimal?mentioning

confidence: 99%

“…So far, while none of the studies on TAD have reported oncological outcome or health-related quality of life, there is limited information available on SLNB alone in this setting. Kahler-Ribeiro-Fontana et al have recently reported on long-term outcomes following SLNB after NACT [3]. Among 222 clinically node-positive patients, 123 had no residual axillary disease at surgery.…”

Section: Is Tad Safe For All Patients?mentioning

confidence: 99%

“…In the SENTINA and the ACOSOG Z1071 trials, FNRs were 12% and 14% respectively, and thus higher than the arbitrarily chosen but widely accepted cut-off value of 10% (Table 3). So far, however, only limited data regarding the oncologic outcome following SLNB alone are available in this setting [3]. Table 1.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Banys‐Paluchowski

Gasparri

Boniface

et al. 2021

Cancers

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In the last two decades, surgical methods for axillary staging in breast cancer patients have become less extensive, and full axillary lymph node dissection (ALND) is confined to selected patients. In initially node-positive patients undergoing neoadjuvant chemotherapy, however, the optimal management remains unclear. Current guidelines vary widely, endorsing different strategies. We performed a literature review on axillary staging strategies and their place in international recommendations. This overview defines knowledge gaps associated with specific procedures, summarizes currently ongoing clinical trials that address these unsolved issues, and provides the rationale for further research. While some guidelines have already implemented surgical de-escalation, replacing ALND with, e.g., sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) in cN+ patients converting to clinical node negativity, others recommend ALND. Numerous techniques are in use for tagging lymph node metastasis, but many questions regarding the marking technique, i.e., the optimal time for marker placement and the number of marked nodes, remain unanswered. The optimal number of SLNs to be excised also remains a matter of debate. Data on oncological safety and quality of life following different staging procedures are lacking. These results provide the rationale for the multinational prospective cohort study AXSANA initiated by EUBREAST, which started enrollment in June 2020 and aims at recruiting 3000 patients in 20 countries (NCT04373655; Funded by AGO-B, Claudia von Schilling Foundation for Breast Cancer Research, AWOgyn, EndoMag, Mammotome, and MeritMedical).

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Section: Introductionmentioning

confidence: 85%

Section: Which Marking Technique Is Optimal?mentioning

confidence: 99%

Section: Is Tad Safe For All Patients?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Banys‐Paluchowski

Gasparri

Boniface

et al. 2021

Cancers

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“…New studies have shown that N1 patients who achieve nodal pathological response after NAC and are treated with SLNB alone have excellent locoregional control, with disease-free and overall survival similar to those who receive complete axillary dissection [33][34][35][36]. In a study from the Memorial Sloan Kettering Cancer Center (MSKCC) in which 234 biopsy-proven N1 patients underwent NAC and had ≥3 negative sentinel nodes removed with no further axillary surgery, the crude 5-year rate of regional recurrence was 1/234 (0.43%) [33].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Nodal Pathological Complete Response in Asian Women with Stage II–III Node-Positive Breast Cancer

et al. 2021

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Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat node-positive (N+) breast cancer. Predictors of nodal pathological complete response (pCR) in Asian women are poorly described and there is variety in the management of the axilla after NAC. We evaluated predictors of nodal pCR and axillary management in a cohort of Asian N+ patients. Methods: Consecutive biopsy-proven N+ breast cancer patients treated with NAC were identified from the Shanghai Ruijin Hospital in China. Axillary lymph node dissection was performed on all patients, irrespective of the nodal response to NAC. Results: A total of 323 patients were included. Nodal pCR was achieved in 105 patients (33%), 15% of HR+/HER2– tumors, 38% of HR+/HER2+ tumors, 49% of HR–/HER2+ tumors, and 42% of HR–/HER2–tumors (p < 0.001). Factors associated with nodal pCR were (1) receptor status (HR+/HER2– [referent]: OR 3.42, 95% CI 1.43–8.16, p = 0.006 for HR+/HER2+; OR 4.19, 95% CI 1.85–9.50, p = 0.001 for HR–/HER2+; and OR 2.94, 95% CI 1.11–7.74, p = 0.029 for HR–/HER2–), (2) breast pCR (no pCR [referent]: OR 15.22, 95% CI 6.29–36.79, p < 0.001), and (3) absence of lymphovascular invasion (LVI [referent]: OR 9.04, 95% CI 2.09–39.18, p = 0.003). Conclusion: This study confirmed expected predictors of nodal pCR in Asian women and the benefit of NAC in downstaging the axilla independently of ethnicity.

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Nodal Recurrence in Patients With Node-Positive Breast Cancer Treated With Sentinel Node Biopsy Alone After Neoadjuvant Chemotherapy—A Rare Event

et al. 2021

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IMPORTANCEProspective trials have demonstrated sentinel lymph node (SLN) false-negative rates of less than 10% when 3 or more SLNs are retrieved in patients with clinically node-positive breast cancer rendered clinically node-negative with neoadjuvant chemotherapy (NAC). However, rates of nodal recurrence in such patients treated with SLN biopsy (SLNB) alone are unknown because axillary lymph node dissection (ALND) was performed in all patients, limiting adoption of this approach. OBJECTIVE To evaluate nodal recurrence rates in a consecutive cohort of patients with clinically node-positive (cN1) breast cancer receiving NAC, followed by a negative SLNB using a standardized technique, and no further axillary surgery. DESIGN, SETTING, AND PARTICIPANTSFrom November 2013 to February 2019, a cohort of consecutively identified patients with cT1 to cT3 biopsy-proven N1 breast cancer rendered cN0 by NAC underwent SLNB with dual tracer mapping and omission of ALND if 3 or more SLNs were identified and all were pathologically negative. Metastatic nodes were not routinely clipped, and localization of clipped nodes was not performed. The study was performed in a single tertiary cancer center.INTERVENTION Omission of ALND in patients with cN1 breast cancer after NAC if 3 or more SLNs were pathologically negative. MAIN OUTCOME AND MEASURESThe primary outcome was the rate of nodal recurrence among patients with cN1 breast cancer treated with SLNB alone after NAC. RESULTSOf 610 patients with cN1 breast cancer treated with NAC, 555 (91%) converted to cN0 and underwent SLNB; 234 (42%) had 3 or more negative SLNs and had SLNB alone. The median (IQR) age of these 234 patients was 49 (40-58) years; median tumor size was 3 cm; 144 (62%) were ERBB2 (formerly HER2)-positive, and 43 (18%) were triple negative. Most (212 [91%]) received doxorubicin-based NAC; 205 (88%) received adjuvant radiotherapy (RT), and 164 (70%) also received nodal RT. At a median follow-up of 40 months, there was 1 axillary nodal recurrence synchronous with local recurrence in a patient who refused RT. Among patients who received RT (n = 205), there were no nodal recurrences.CONCLUSIONS AND RELEVANCE This cohort study found that in patients with cN1 disease rendered cN0 with NAC, with 3 or more negative SLNs with SLNB alone, nodal recurrence rates were low, without routine nodal clipping. These findings potentially support omitting ALND in such patients.

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Long-term standard sentinel node biopsy after neoadjuvant treatment in breast cancer: a single institution ten-year follow-up

Cited by 103 publications

References 41 publications

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Predictors of Nodal Pathological Complete Response in Asian Women with Stage II–III Node-Positive Breast Cancer

Nodal Recurrence in Patients With Node-Positive Breast Cancer Treated With Sentinel Node Biopsy Alone After Neoadjuvant Chemotherapy—A Rare Event

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