Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer - a prospective study

Abstract

BackgroundSentinel lymph node biopsy (SLNB) is now considered a standard of care in early breast cancers with N0 axillae; however, its role in locally advanced breast cancer (LABC) after neo-adjuvant chemotherapy (NACT) is still being debated. The present study assessed the feasibility, efficacy and accuracy of sentinel lymph node biopsy (SLNB) using "dye alone" (methylene blue) method in patients with LABC following NACT.Materials and methodsThirty, biopsy proven cases of LABC that had received three cycles of neo-adjuvant chemotherapy (cyclophosphamide, adriamycin, 5-fluorouracil) were subjected to SLNB (using methylene blue dye) followed by complete axillary lymph node dissection (levels I-III). The sentinel node(s) was/were and the axilla were individually assessed histologically. The SLN accuracy parameters were calculated employing standard definitions. The SLN identification rate in the present study was 100%. The sensitivity of SLNB was 86.6% while the accuracy was 93.3%, which were comparable with other studies done using dual lymphatic mapping method. The SLN was found at level I in all cases and no untoward reaction to methylene blue dye was observed.ConclusionsThis study confirms that SLNB using methylene blue dye as a sole mapping agent is reasonably safe and almost as accurate as dual agent mapping method. It is likely that in the near future, SLNB may become the standard of care and provide a less morbid alternative to routine axillary lymph node dissection even in patients with LABC that have received NACT.

The Paradigm Shifts in the Management of Breast Cancer—Have We Finally Arrived?

“…!-A Randomized, Phase III Clinical Trial to Compare Sentinel Node Resection to Conventional Axillary Dissection in Clinically Node-Negative Breast Cancer Patients]. The options to use SLNB in locally advanced breast cancer after neo-adjuvant chemotherapy are also being explored and may actually become the standard of care in future [16][17][18][19].…”

“…Targeted Therapy [15][16][17][18][19] While the local treatment is becoming more and more conservative, the systemic treatment is getting more and more aggressive. This is associated with unacceptable toxicity and collateral damage, for little or no extra gain in terms of outcome.…”

Sentinel Lymph Node Biopsy in Breast Cancer-Should It Be the Standard of Care in India?

“…The recommendations from American Society Of Clinical Oncology (ASCO) that have been published recently showed that routine SLNB is acceptable and recommended for early stage breast cancer in clinically node negative disease [4]. There is however a debate regarding the timing of the SLND or SLNB in patients receiving NACT.…”

“…SLNB is associated with less than 1 % isolated axillary recurrence in node negative disease and provides an excellent regional nodal control [5,6]. The author has published a validation study indicating the reliability of SLNB using dye alone method in patients after neo-adjuvant chemotherapy [4].…”

“…Considering the shear burden of the disease,delayed presentation and lack of facilities in most centres, it is not likely that the minimally invasive approach to axilla i.e. Sentinel Lymph Node Biopsy (SLNB) becomes the standard of care in this part of the world in the near future [1][2][3][4].…”