Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Patients With an Initial Diagnosis of Cytology-Proven Lymph Node-Positive Breast Cancer

Enokido, Katsutoshi; Watanabe, Chie; Nakamura, Seigo; Ogiya, Akiko; Osako, Tomo; Akiyama, Futoshi; Yoshimura, Akinobu; Iwata, Hiroji; Ohno, Shinji; Kojima, Yasuyuki; Tsugawa, Koichiro; Motomura, Kazuyoshi; Hayashi, Naoki; Yamauchi, Hideko; Sato, Nobuaki

doi:10.1016/j.clbc.2016.02.009

Cited by 42 publications

(46 citation statements)

References 30 publications

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“…From 655 articles identified by the search, a total of 13 studies published between 2007 and 2017 met the inclusion criteria and were included in the analysis ( Fig . and Table ). Almost all included studies were prospective and included a total of 1921 patients.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer

Tee

Devane

Evoy

et al. 2018

British Journal of Surgery

116

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Background Neoadjuvant chemotherapy for breast cancer has the potential to achieve a pathological complete response in up to 40 per cent of patients, converting disease that was initially node‐positive to node‐negative. This has raised the question of whether sentinel lymph node biopsy could be an alternative to axillary lymph node dissection in these patients. The aim was to undertake a systematic review and meta‐analysis of the accuracy and reliability of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy‐proven node‐positive breast cancer. Methods A literature search was conducted using PubMed, Ovid MEDLINE, Embase and Web of Science databases up to 30 April 2017. Inclusion criteria for studies were pathological confirmation of initial node‐positive disease, and sentinel lymph node biopsy performed after neoadjuvant chemotherapy followed by axillary lymph node dissection. Results A total of 13 studies met the inclusion criteria and were included in the analysis (1921 patients in total). The pooled estimate of identification rate was 90 (95 per cent c.i. 87 to 93) per cent and the false‐negative rate was 14 (11 to 17) per cent. In subgroup analysis, the false‐negative rate with use of dual mapping was 11 (6 to 15) per cent, compared with 19 (11 to 27) per cent with single mapping. The false‐negative rate was 20 (13 to 27) per cent when one node was removed, 12 (5 to 19) per cent with two nodes removed and 4 (0 to 9) per cent with removal of three or more nodes. Conclusion Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with biopsy‐proven node‐positive breast cancer is accurate and reliable, but requires careful patient selection and optimal surgical techniques.

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer

Tee

Devane

Evoy

et al. 2018

British Journal of Surgery

116

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“…The most common spreading method of breast cancer is by lymphatic metastasis, and understanding the distribution of metastasis is key to the success of surgical therapy (13). MSCT is characterized by its high speed, thin sections and high definition and can identify many latent tumor lesions.…”

Section: Discussionmentioning

confidence: 99%

The use of sequential X-ray, CT and MRI in the preoperative evaluation of breast-conserving surgery

Zhang

Tan

Gao

et al. 2016

Experimental and Therapeutic Medicine

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The aim of the study was to investigate the value of sequential application of molybdenum target X-ray, multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) in the preoperative evaluation of breast-conserving surgeries. In total, 76 patients with indications for breast-conserving surgery due to complicated breast cancer participated in the study and were assigned to either control or observation group (n=38 per group). The patients in the control group were evaluated with two sets of random combinations of molybdenum target X-ray, MSCT or MRI with ultrasound inspection, whereas the patients in the observation group were evaluated by sequential inspection methods of molybdenum target X-ray, MSCT and MRI. A comparison of surgery outcomes, incidence of complications, rate of positive surgical margins, and recurrence and survival rates in the groups during a follow-up period of 24 months was made. Comparisons of the preoperative evaluation results for tumor number, average maximum diameter, number of lymphatic metastatic groups and number of metastatic lymph nodes in the observation group showed the numbers to be significantly higher than those in the control group (P<0.05). Conversely, the comparisons of age, tumor distribution and T-staging yielded no significant differences, validating the analysis. The percentage of successful breast-conserving surgeries in the observation group was significantly higher than that in the control group, while the incidence of complications in the observation group was lower (P<0.05). The rate of positive surgical margins and the recurrence rate of cancer in the observation group were lower than those in the control group, and the survival rate in the observation group was higher, with differences having statistical significance (P<0.05). In conclusion, the sequential application of molybdenum target X-ray, MSCT and MRI during the preoperative evaluation for breast-conserving surgery positively affects the success rate of the procedure improving the diagnostic accuracy and therapeutic effects.

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“…Additionally, in this trial, the rate of false negatives was 9.1% in cases where three or more sentinel lymph nodes were successfully excised. Within Japan, Enokido et al conducted a study of 143 cases at eight facilities that analyzed sentinel lymph node biopsy following NAC in cases that were positive for clinical axillary lymph node metastasis [5]. The rate of false negatives for all cases was 16.0% (13/81), a higher value than the two studies mentioned previously.…”

Section: Downstaging By Neoadjuvant Chemotherapy For Clinical Node-pomentioning

confidence: 94%

“…Based on this, we believe that, in cases that are positive for clinical axillary lymph node metastasis, it is better to excise as many sentinel lymph nodes (preferably three or more) as possible in order to achieve highly accurate axillary lymph node analysis following NAC. However, due to blockage caused by lymph duct cancer cells or scarring in lymph nodes that had already metastasized, it is often difficult to evaluate sentinel lymph node biopsies following NAC in cases that were positive for clinical axillary lymph node metastasis, and the rate of identification is about 87.8% to 92.7% [3][4][5]. Furthermore, in cases where three or more sentinel lymph nodes were successfully excised, the rates were 34% (201/592) in the SENTINA trial, 56.3% (388/689) in the Z1071 trial, and 9.1% in the Enokido study.…”

Section: Downstaging By Neoadjuvant Chemotherapy For Clinical Node-pomentioning

confidence: 99%

Feasibility study of clipped node resections with Crystal crystal Violet violet dye marking in patientswith biopsy provenwho underwent biopsies for metastatic lymph nodes:Targeted tTargeted Axillary axillary Dissection dissections in Japann

Takemae¹,

Harao²,

Hoshi³

et al. 2018

Integr Cancer Sci Therap

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De-escalation of surgery for axillary lymph nodes in breast cancer treatment has advanced following the development of the sentinel lymph node biopsy procedure for clinical axillary lymph node metastasis-negative breast cancer. Sentinel lymph node biopsy procedures following downstaging by neoadjuvant chemotherapy (NAC) in clinical axillary lymph node metastasis-positive cases provide such advancements. However, sentinel lymph node biopsies performed after NAC have a high false negative rate (12.6-14.6%) and are unable to provide a definitive basis for assessing axillary lymph node metastases. Targeted axillary dissection (TAD) is a new method designed to overcome these disadvantages by allowing for more accurate assessment of axillary lymph node metastases following NAC through the placement of clips at lymph nodes with metastasis prior to NAC, and such procedures have been attracting research attention. I125 seed labeling and wire localization were frequently performed in prior studies as methods for extracting indwelled clips from lymph nodes, but these methods were considered to be invasive, and their adoption in Japan was not achieved. For this study, we designed a variant of the TAD method involving labeling indwelled lymph node clips using pyoktanin dye (crystal violet), and we believe this method could potentially be adopted in Japan.Correspondence to: Masaru Takemae, Department of Surgery, Tochigi Cancer Center Utsunomiya city, Yonan, 4-9-13, Japan, Tel: +81-28-658-5151, E-mail: masaruta@tochigi-cc.jp The current axillary surgery for breast cancer Primary breast cancer therapies include localized treatments, such as surgery and radiation therapy, and multidisciplinary approaches, such as a combination of systemic therapies that include hormone therapy, chemotherapy, and molecular-targeted therapy. Localized treatment has gradually decreased, due to advances in systemic therapy. The NSABP B-32 trial demonstrated that in cases that are negative for clinical axillary lymph node metastasis, additional axillary dissection does not affect prognosis if the patient is negative for sentinel lymph node metastasis [1]. Owing to this, the new standard procedure for surgery is not to perform axillary dissection in cases that are negative for clinical axillary lymph node metastasis if the patient is negative for sentinel lymph node metastasis. Additionally, the Z0011 trial demonstrated that axillary dissection can be avoided under the following condition: if there are two or fewer macro-metastases to the sentinel lymph nodes, then breast-conserving surgery is performed when the tumor T stage is T2 or below, and appropriate systemic therapy is introduced [2]. Downstaging by neoadjuvant chemotherapy for clinical node-positive breast cancerIn cases that are negative for clinical axillary lymph node metastasis, de-escalation of axillary treatment is progressing. However, axillary dissection is still the standard axillary treatment in cases where axillary lymph node metastasis has been observed clinically.For some...

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Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Patients With an Initial Diagnosis of Cytology-Proven Lymph Node-Positive Breast Cancer

Cited by 42 publications

References 30 publications

Meta-analysis of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer

Meta-analysis of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer

The use of sequential X-ray, CT and MRI in the preoperative evaluation of breast-conserving surgery

Feasibility study of clipped node resections with Crystal crystal Violet violet dye marking in patientswith biopsy provenwho underwent biopsies for metastatic lymph nodes:Targeted tTargeted Axillary axillary Dissection dissections in Japann

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