Sentinel Node Biopsy After Neoadjuvant Systemic Therapy for Breast Cancer: The Method Matters

Bear, Harry D.; McGuire, Kandace P.

doi:10.1245/s10434-019-07401-z

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…Residual disease is very important because it reflects the patient prognosis and the need for adjuvant treatment after neoadjuvant treatment [110].…”

Section: Axillary Surgery In N2-n3 Patientsmentioning

confidence: 99%

Role of sentinel node biopsy in breast cancer: a review

2021

EJGO

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Axillary lymph node involvement is still an important predictor of recurrence and survival in breast cancer. Axillary staging was classically done by axillary lymph node dissection (ALND), but the introduction of sentinel lymph node biopsy (SLNB) has led to a progressive and continuing de-escalation in its use. Therefore, SLNB can now be considered the standard procedure for axillary staging in clinically N0 patients. Different studies have also begun to report that a positive sentinel node does not always require ALND, reducing the morbidity derived from this technique. Fears that this sentinel node approach might not be accurate for neoadjuvant chemotherapy have been allayed by several studies showing that post-neoadjuvant SLNB in clinical N0 patients reduces the rate of ALND. This approach benefits from axillary pathological complete response with an acceptable false-negative rate. By contrast, however, cN1 disease still requires that we optimise the technique to reduce the rate of false negatives. Currently, SLNB is the best method for axillary staging in breast cancer, allowing patients to be treated according to risk of recurrence, and with good evidence that morbidity is lower than with other more radical techniques.

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“…Residual disease is very important because it reflects the patient prognosis and the need for adjuvant treatment after neoadjuvant treatment [110].…”

Section: Axillary Surgery In N2-n3 Patientsmentioning

confidence: 99%

Role of sentinel node biopsy in breast cancer: a review

2021

EJGO

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Neoadjuvant Therapy in Breast Cancer

Troxell

Gupta

2022

Surgical Pathology Clinics

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The Dual Method (Dye and Ultrasound) for Axillary Mapping in Patients Receiving Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer

Kumar¹,

Chintamani²,

Naghma³

et al. 2022

Journal of Medical Sciences

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Background: Sentinel lymph node (SLN) remains one of the most important indicators of axillary lymph node status, defining the prognosis of breast cancer (BC) patients. The present study was done to map axillary SLN using dual method of intraoperative axillary ultrasound-guided (USG) and methylene blue dye, in patients receiving neoadjuvant chemotherapy (NAT) for locally advanced BC. Methods: A prospective interventional cross-sectional study was conducted on 36 core-needle biopsy-proven cases of locally advanced breast carcinoma (Stage IIb and Stage III) who received NAT. The SLNs as identified by the bluest staining node (dye method) and the node with a needle inserted in it through axillary USG method were dissected and sent for frozen section in normal saline. It was followed by complete axillary dissection and final histopathology reporting. Diagnostic test was used for calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: After NAT, 26/29 patients with pre-NAT staging of N1 and 5/7 patients with pre-NAT staging of N2 showed significant downstaging of the nodal status after NAT (P < 0.001). We found that the dual method showed similar sensitivity to the dye method and the USG method (94.74%). But, the specificity, PPV, and NPV of the dual method although similar to the dye method (76.47%, 81.82%, and 92.86%, respectively) were lower than that of the USG method (82.35%, 85.71%, and 93.33%, respectively). Conclusion: In conclusion, dual method (dye and USG) is a good attempt in increasing the SLN detection but it is not a powerful test in the application of avoiding axillary lymph node dissection. The comparable sensitivity but lower specificity in determining the SLN restricts its use, and warrants future studies with contrast-enhanced USG to decrease the false negatives.

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Sentinel Node Biopsy After Neoadjuvant Systemic Therapy for Breast Cancer: The Method Matters

Cited by 3 publications

References 34 publications

Role of sentinel node biopsy in breast cancer: a review

Role of sentinel node biopsy in breast cancer: a review

Neoadjuvant Therapy in Breast Cancer

The Dual Method (Dye and Ultrasound) for Axillary Mapping in Patients Receiving Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer

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