Role of gamma probe-assisted intraoperative sentinel lymph node evaluation in predicting axillary breast cancer metastasis after neoadjuvant chemotherapy

Abstract

Objective Intraoperative sentinel lymph node biopsy is a universally accepted technique to identify patients who are candidates for axillary lymph node dissection during breast cancer surgery. However, there is controversy over its use in patients who underwent preoperative neoadjuvant chemotherapy. This study aimed to examine the diagnostic value of gamma probe-assisted intraoperative sentinel lymph node examination with frozen section in breast cancer patients who had undergone preoperative neoadjuvant chemotherapy. Methods This retrospective study included 94 tumors diagnosed with stage IIA, IIB or IIIA invasive breast cancer with locoregional lymph node metastasis who underwent surgical treatment after neoadjuvant chemotherapy. Intraoperatively, axillary sentinel lymph node sampling was done using radioactive colloid and gamma probe and materials were examined with frozen section method. Patients with positive sentinel nodes underwent axillary resection. Histopathological examination of all surgical samples was done postoperatively. Results In 87 of 94 tumors (92.6%), a sentinel lymph node could be identified using the method. The sensitivity, specificity and accuracy of the method for predicting axillary macro metastasis were 85.7, 86.5 and 86.2%, respectively, with 5.7% false negative rate. Conclusions Sentinel lymph node identification using preoperative scintigraphy and intraoperative use of gamma probe seems to be a feasible and efficient method in terms of differentiating patients that require axillary lymph node dissection during breast cancer surgery, even when they have received neoadjuvant chemotherapy. Further large prospective studies allowing subgroup analyses are warranted.

Feasibility and reliability of sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients with positive axillary nodes at initial diagnosis: An up-to-date meta-analysis of 3,578 patients

“…In accordance with the search strategy and study selection criteria, a total of 3578 participants (mean 133 per study, range: 26–637) in 27 trials were identified for inclusion in this meta-analysis ( Fig. 1 a) [ 5 , [9] , [10] , [11] , 16 , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [47] ]. The publication dates of these studies ranged from 2004 to 2020.…”

“…Twenty-two studies were single-center studies [ 5 , 9 , 11 , 25 , 26 , [28] , [29] , [30] , [31] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] ], and five other studies were multi-center studies [ 10 , 16 , 27 , 32 , 47 ]. Seventeen of 27 studies were prospective studies [ 5 , 10 , 16 , 25 , 27 , 29 , 31 , 32 , [34] , [35] , [36] , 40 , [42] , [43] , [44] , [45] , 47 ].…”

“…Seventeen of 27 studies were prospective studies [ 5 , 10 , 16 , 25 , 27 , 29 , 31 , 32 , [34] , [35] , [36] , 40 , [42] , [43] , [44] , [45] , 47 ]. The others were retrospective studies [ 9 , 11 , 26 , 28 , 30 , 33 , [37] , [38] , [39] , 41 ]. Seven studies were from Korea [ 9 , 31 , [34] , [35] , [36] , 38 , 39 ], five were from the United States [ 11 , 16 , 25 , 28 , 40 ], three were from China [ 33 , 43 , 45 ], three were from Japan [ 32 , 41 , 44 ], two were from India [ 30 , 42 ], two were from Turkey [ 26 , 37 ], and one each was from France, Germany, Italy, Canada, and Sweden.…”

“…The others were retrospective studies [ 9 , 11 , 26 , 28 , 30 , 33 , [37] , [38] , [39] , 41 ]. Seven studies were from Korea [ 9 , 31 , [34] , [35] , [36] , 38 , 39 ], five were from the United States [ 11 , 16 , 25 , 28 , 40 ], three were from China [ 33 , 43 , 45 ], three were from Japan [ 32 , 41 , 44 ], two were from India [ 30 , 42 ], two were from Turkey [ 26 , 37 ], and one each was from France, Germany, Italy, Canada, and Sweden. Four out of 27 studies did not confirm the axillary status of patients by fine needle aspiration (FNA) or core needle biopsy (CNB) [ 10 , 29 , 30 , 35 ].…”

“…Four out of 27 studies did not confirm the axillary status of patients by fine needle aspiration (FNA) or core needle biopsy (CNB) [ 10 , 29 , 30 , 35 ]. In terms of mapping agents, blue dye (BD) alone was applied across three studies [ 30 , 42 , 45 ], radioisotopes (RI) alone were used in four studies [ 26 , 29 , 35 , 39 ], both tracers were used in four studies [ 5 , 9 , 36 , 44 ], and mixed means were used in the remaining studies. The mean or median number of SLNs retrieved in each study is displayed in Table 2 .…”