Sentinel Node Biopsy Before Neoadjuvant Chemotherapy for Determining Axillary Status and Treatment Prognosis in Locally Advanced Breast Cancer

Cox, Charles E.; Cox, John M.; White, Laura; Stowell, Nicholas; Clark, John D.; Allred, Nathon; Meyers, Michael P.; Dupont, Elisabeth; Furman, Ben; Minton, Susan

doi:10.1245/aso.2006.03.592

Cited by 54 publications

(34 citation statements)

References 35 publications

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“…The pathologic complete response rate with neoadjuvant chemotherapy for patients with known positive axillary lymph node reported rages from 11 to 60% [16][17][18][19]. We observed that the subset of patients treated with DE presented a substantial gain in terms of axillary pCR when compared to the subset of patients treated with FEC.…”

Section: Discussionmentioning

confidence: 71%

Taxane-based chemotherapy enhances response to neoadjuvant treatment for stage II and III breast cancer

et al. 2010

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Reducing primary tumor volume is the main role of neoadjuvant chemotherapy for breast cancer. We evaluated the benefit of adding docetaxel to anthracyclin as neoadjuvant therapy. This study is a retrospective cohort analysis comparing the efficacy of neoadjuvant chemotherapy in patients subjected to docetaxel and epirubicin or 5-fluoruracil, epirubicin and cyclophosphamide combinations (DE and FEC group, respectively). The mean number of chemotherapy delivered was similar in both groups (P = 0.8). A total of 316 patients were treated (151 in FEC group and 165 in DE group). Primary endpoint was the clinical and pathological response to therapy. Breast conserving surgery rate was compared. In T1/2 staged patients, the complete clinical response rate was 7.5% in FEC group and 32% in DE group (P = 0.002), and the breast conserving surgery rate was 72 and 73% in FEC and DE groups, respectively (P = 0.9). In the subset of patients staged as T3 and T4a-c, objective response was higher in DE group (P < 0.0001 and P = 0.008, respectively). Breast conserving surgery rate was 38 and 63% in FEC and DE groups, respectively, in T3 staged patients and, 20.5 and 37% in T4a-c staged patients (P = 0.003 and 0.08). Despite the similar number of chemotherapy cycles delivered in both groups, the presence of microscopic axillary lymph node involvement after chemotherapy was less frequent in DE group. Neoadjuvant chemotherapy with DE combination is more effective in terms of clinical and pathological response propitiating higher breast conserving surgery rate than FEC combination in stage II and III breast cancer.

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Section: Discussionmentioning

confidence: 71%

Taxane-based chemotherapy enhances response to neoadjuvant treatment for stage II and III breast cancer

et al. 2010

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“…They found that occult metastases were found in 10% of patients with histologically negative axilla. A study by Cox et al 30 demonstrated that 27% of their patients had a complete pathologic axillary response, and these patients had a higher overall survival than patients with residual disease. Xing et al 31 conducted a meta-analysis of 21 studies that examined the results of SLN biopsy after chemotherapy.…”

Section: Role Of Slnb In Patients Undergoingmentioning

confidence: 99%

The Ever-Changing Role of Sentinel Lymph Node Biopsy in the Management of Breast Cancer

Goodman

O’Connor

Kandil

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Axillary nodal status remains one of the most important prognostic indicators in the management of breast cancer. Axillary node metastases are seen in fewer than half of breast cancer cases, and axillary lymph node dissection is associated with significant morbidity. Sentinel lymph node biopsy (SLNB) has become the gold standard for axillary staging of breast cancer.Objective.-To present a detailed review of the existing studies on SLNB in relation to the various techniques, the pathologic evaluation of the sentinel node, and special situations that can involve SLNB. We discuss recent trials that have already had an influence on surgical and pathologic management of breast cancer. In this article, we also discuss our practice and experience at UMass Memorial Medical Center, Worcester, Massachusetts, from a pathologic and surgical perspective.Data Sources.-Published articles from peer-reviewed journals in PubMed (US National Library of Medicine).Conclusions.-Sentinel node biopsy has become standard of care in the surgical management of breast cancer, and emerging data show that the survival benefits of axillary lymph node dissection may not be greater than sentinel node biopsy alone in patients with up to 2 positive sentinel nodes. Therefore, there have been recent changes to the role of intraoperative sentinel node evaluation, and an impact on overall breast cancer management.

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“…Contrary to the high number of studies reporting SLNB after NAC, only a few studies have reported the results of performing SLNB before NAC. [16][17][18][19][20][21][22][23] The candidates for SLNB in this setting were patients with large tumors and clinically negative nodes before NAC. Two studies demonstrated that SLNB can also provide accurate results in patients with large breast tumors not treated with chemotherapy.…”

Section: Sentinel Lymph Node Biopsy Before Neoadjuvant Chemotherapymentioning

confidence: 99%

“…SLNB is considered to be contraindicated for patients on NAC for several reasons; however, many studies have reported positive results of SLNB before and/or after NAC. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In this review article, we discuss the issues surrounding SLNB performed before or after NAC by reviewing the published literature and our experience, based on which we assess the optimal timing for SLNB in the NAC setting.…”

Section: Introductionmentioning

confidence: 99%

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

Shimazu

Noguchi

2011

Surg Today

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Axillary lymph node status is the most important prognostic factor in the treatment of breast cancer. In recent years, sentinel lymph node biopsy (SLNB) has replaced conventional axillary lymph node dissection for predicting axillary lymph node status with higher accuracy. Moreover, neoadjuvant chemotherapy (NAC) is being used increasingly to treat not only patients with locally advanced inoperative breast cancer, but also those with initially operable breast cancer. The application of SLNB has now expanded to include this patient population, who were not previously considered good candidates for SLNB. A number of recent studies have evaluated the feasibility and accuracy of SLNB after NAC in breast cancer patients. Moreover, SLNB has been shown to be accurate in patients scheduled to receive NAC, and repeat SLNB has been performed after NAC for patients with positive nodes detected by the initial SLNB before NAC. Thus, the optimal timing of SLNB for patients with breast cancer in the neoadjuvant setting remains controversial. This article reviews the issues surrounding SLNB before vs. after NAC, according to the published literature and our experience.

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Sentinel Node Biopsy Before Neoadjuvant Chemotherapy for Determining Axillary Status and Treatment Prognosis in Locally Advanced Breast Cancer

Cited by 54 publications

References 35 publications

Taxane-based chemotherapy enhances response to neoadjuvant treatment for stage II and III breast cancer

Taxane-based chemotherapy enhances response to neoadjuvant treatment for stage II and III breast cancer

The Ever-Changing Role of Sentinel Lymph Node Biopsy in the Management of Breast Cancer

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

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