Primary Chemotherapy Effect in Sentinel Node Detection in Breast Cancer

Abstract

Preoperative chemotherapy seems to impair axillary evaluation by SN biopsy and should be used cautiously in this subset of patients.

Sentinel node identification rate, but not accuracy, is significantly decreased after pre-operative chemotherapy in axillary node-positive breast cancer patients

“…Reports on the efficacy of SNB after pre-operative chemotherapy have been inconsistent [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], leading to suggestions that chemotherapy may interfere with the anatomy or physiology of the lymphatics and adversely affect its accuracy. In meta-analysis of SNB after pre-operative chemotherapy in patients with breast cancer, it shows that SNB is a reliable tool for planning treatment after pre-operative chemotherapy.…”

Lymphoscintigraphy in breast cancer: a short review about the impact on upper limb after surgical treatment

“…Another discussion is the elimination or not of SLN before neoadjuvant chemotherapy, because there may be a complete response with regression in the metastases of some lymph nodes, but the disease may remain in other ones (Noguchi et al, 2004). In contrast, Vigário et al (2003), reported that the accuracy of axillary staging after therapy is not well defined and may be associated with an increase of false negative results in these patients because chemotherapy may influence the standard drainage and, consequently, the responses of metastasis to therapy are different (Vigário et al, 2003). The absolute contraindications are: clinically positive axilla, core biopsy or fine needle aspiration biopsy with tumoral infiltration, allergy to vital blue dye and/or radiocolloid.…”

“…The relative contraindications are: previous biopsy or previous axillary surgery to remove some lymph nodes which occur during the procedure reflecting on the tumour's primary site; in these cases, lymphoscintigraphy has a fundamental role, in advanced stages, the tumour's size, multifocal and multicentric disease. Some authors report that age and body mass index also influence in the detection of SL because adipose tissue is supposed to reduce lymphatic fluid in such tissues (Vigário et al, 2003;Filippakis and Zografos, 2007). The aim of the detection of the SLN is to reduce postoperative morbidity resulting from axillary lymphadenectomy and maintain the correct staging of axilla in breast cancer.…”

“…The key to determining the treatment of breast cancer is the stage of the disease and the patient's clinical condition, the status of axillary lymph nodes being fundamental due to its clinical importance to cancer dissemination. Moreover, it is considered the most important factor of prognostic and one of the recommendation criteria for the implementation of local or systemic therapy (Vigário et al, 2003;James and Edge, 2006). Historically, the standard procedure for obtaining information about axillary node involvement has been the axillary lymphadenectomy, which is responsible for substantial morbidities, short and long term, such as sensitivity alterations, nervous injury, motor dysfunctions and risk of developing lymphedema which contributes to functional loss, infections of the ipsilateral upper-limb to axillary and other complications (James and Edge, 2006).…”

Advantage of sentinel lymph node biopsy before neoadjuvant chemotherapy in breast cancer treatment

“…T, tumor size; NAET, neoadjuvant endocrine therapy age patterns by shrinkage and fi brosis of the lymph vessels, inducing fatty degeneration associated with apoptosis of the tumor cells, and by the potential obstruction of lymphatic channels with cellular material or tumor emboli. [33][34][35] Second, the action of NAC on lymph nodes may lead to false negatives, through differing levels of response. For example, while NAC may destroy the metastases in the SLN, residual foci may remain in the non-SLNs.…”