The Shift From Sentinel Lymph Node Biopsy Performed Either Before or After Neoadjuvant Systemic Therapy in the Clinical Negative Nodes of Breast Cancer Patients. Results, and the Advantages and Disadvantages of Both Procedures

Fernández-González, Sergi; Falo, Catalina; Jesús, María; Pernas, Sònia; Bajén, M.T.; Soler, Teresa; Ortega, Raúl; Quetglas, Cecilia; Perez-Martin, X.; Montoli, Maria Eulalia Fernandez; Campos, Marliane Batista; Varela, Mar; Ponce, Jordi; García‐Tejedor, Amparo

doi:10.1016/j.clbc.2017.08.014

Cited by 22 publications

(20 citation statements)

References 37 publications

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“…Finally, according to our data, when both groups ypN0 and ypN+ were compared by molecular‐like subtype strata, the differences in DDFS and OS between subtypes were minimal in patients who were downgraded to ypN0. Therefore, as we have published elsewhere, the response to NACT significantly affected the initially different prognosis of each molecular subtype (Figure ).…”

Section: Resultssupporting

confidence: 66%

Predictive factors for omitting lymphadenectomy in patients with node‐positive breast cancer treated with neo‐adjuvant systemic therapy

Fernández-González¹,

Falo

María³

et al. 2020

Breast J

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Abbreviations: ALND, axillary lymph node dissection; cN+, node-positive; DDFS, distant disease-free survival; DFS, disease-free survival; NACT, neo-adjuvant chemotherapy; OS, overall survival; pCR, pathologic complete response; SLNB, sentinel lymph node biopsy; ypN0, pathologic complete response in lymph nodes; ypT0, pathologic complete response in breast. AbstractA pathologic complete response (pCR) in the axilla occurs in 30%-40% of patients with initially node-positive breast cancer after neo-adjuvant chemotherapy (NACT). Debate persists about whether to perform systematic axillary lymphadenectomy (ALND) in patients with initial node-positive disease and clinical complete response after NACT. We aimed to identify predictive factors of axillary pCR (ypN0) after NACT. This retrospective study analyzed data for all patients with initial biopsy-proven node-positive disease who underwent ALND after NACT between June 2008 and December 2016 at our institution. Clinical and pathologic features, recurrence and specific mortality rates were compared between patients who achieved an axillary pCR and those who did not (ypN0 vs ypN+, respectively). A total of 331 patients were included, of whom 128 (38.7%) became ypN0 after NACT. Among patients with >2 suspicious axillary lymph nodes before treatment, 54 (38%) achieved ypN0 status. The independent predictors of ypN0 were Ki-67 > 30 (OR 1.98; 95% CI, 1.146-3.381), HER2 positivity (OR 2.6; 95% CI, 1.354-5.108), nonluminal molecular-like subtype (OR 4.15; 95% CI, 2.068-5.108), and clinical complete response, defined as negative clinical and ultrasonographic findings (OR 2.8; 95% CI, 1.110-7.081). After a mean follow-up of 61 months, distant disease-free and overall survival rates were higher in patients with ypN0 disease (HR 4.14; 95% CI, 2.03-8.43) than ypN+ patients. Complete clinical response and the presence of nonluminal molecular-like subtypes independently predicted ypN0. Patients meeting these criteria might be suitable form omitting ALND and just performing targeted axillary procedures to patients meeting these criteria. | 889FERNANDEZ-GONZALEZ Et AL. FERNANDEZ-GONZALEZ Et AL. AUTH O R CO NTR I B UTI O N SSergi Fernandez-Gonzalez involved in conceptualization, methodology, formal analysis, data curation,and writing of the manuscript.Catalina Falo and Amparo Garcia-Tejedor involved in conceptualization, methodology, writing, and supervision of the manuscript. Maria

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Section: Resultssupporting

confidence: 66%

Predictive factors for omitting lymphadenectomy in patients with node‐positive breast cancer treated with neo‐adjuvant systemic therapy

Fernández-González¹,

Falo

María³

et al. 2020

Breast J

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“…Die neoadjuvante Systemtherapie erlaubt neben einer Senkung der operativen Morbidität (mehr Brusterhaltung, weniger axilläre Lymphonodektomien) die In-vivo-Sensitivitätstestung 99 , 100 . Anhand der Wirkung der neoadjuvanten Systemtherapie auf den Primärtumor kann deren Effekt auf die Langzeitprognose, möglicherweise durch die Zerstörung bzw.…”

Section: Vorteile Der Neoadjuvanten Therapieunclassified

Update Breast Cancer 2019 Part 1 – Implementation of Study Results of Novel Study Designs in Clinical Practice in Patients with Early Breast Cancer

Hartkopf

Müller

Wöckel

et al. 2019

Geburtshilfe Frauenheilkd

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For many years, small but significant advancements have been made time and again in the prevention and treatment of early breast cancer. The so-called panel gene analyses are becoming more and more important in prevention, since the risk due to the tested genes is better understood and as a result, concepts for integration in health care can be developed. In the adjuvant situation, the first study in the so-called post-neoadjuvant situation was able to demonstrate a clear improvement in the prognosis with an absent pathological complete remission following trastuzumab or pertuzumab + trastuzumab. Additional studies with this post-neoadjuvant therapeutic concept are still being conducted at present. The CDK4/6 inhibitors which had shown a significant improvement in progression-free survival in a metastatic situation are currently being tested in the adjuvant situation in large therapeutic studies. These and other new data for the treatment or prevention of primary breast cancer are presented in this review against the backdrop of current studies.

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“…Neoadjuvant chemotherapy permits in vivo testing of response and thus allows monitoring of individual tumor response. Down staging malignant lesions allows reduction in surgical complications, more conservative surgeries, and safer axillary dissections [23,24]. The utilization of noninvasive imaging in monitoring the response of malignant breast lesions to NAC has become crucial.…”

Section: Discussionmentioning

confidence: 99%

Quantitative mathematical objective evaluation of contrast-enhanced spectral mammogram in the assessment of response to neoadjuvant chemotherapy and prediction of residual disease in breast cancer

Moustafa

Kamal

Gomaa

et al. 2019

Egypt J Radiol Nucl Med

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Background: The aim of the study is to initiate a new quantitative mathematical objective tool for evaluation of response to neoadjuvant chemotherapy (NAC) and prediction of residual disease in breast cancer using contrastenhanced spectral mammography (CESM). Forty-two breast cancer patients scheduled for receiving NAC were included. All patients underwent two CESM examinations: pre and post NAC. To assess the response to neoadjuvant chemotherapy, we used a mathematical image analysis software that can calculate the difference in the intensity of enhancement between the pre and post neoadjuvant contrast images (MATLAB and Simulink) (Release 2013b). The proposed technique used the pre and post neoadjuvant contrast images as inputs. The technique consists of three main steps: (1) preprocessing, (2) extracting the region of interest (ROI), and (3) assessment of the response to chemotherapy by measuring the percentage of change in the intensity of enhancement of malignant lesions in the pre and post neoadjuvant CESM studies using a quantitative mathematical technique. This technique depends on the analysis of number of pixels included within the ROI. We compared this technique with the currently used method of evaluation: RECIST 1.1 (response evaluation criteria in solid tumors 1.1) and using another combined response evaluation approach using both RECIST 1.1 in addition to a subjective visual evaluation. Results were then correlated with the postoperative pathology evaluation using Miller-Payne grades. For statistical evaluation, patients were classified into responders and non-responders in all evaluation methods.

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The Shift From Sentinel Lymph Node Biopsy Performed Either Before or After Neoadjuvant Systemic Therapy in the Clinical Negative Nodes of Breast Cancer Patients. Results, and the Advantages and Disadvantages of Both Procedures

Cited by 22 publications

References 37 publications

Predictive factors for omitting lymphadenectomy in patients with node‐positive breast cancer treated with neo‐adjuvant systemic therapy

Predictive factors for omitting lymphadenectomy in patients with node‐positive breast cancer treated with neo‐adjuvant systemic therapy

Update Breast Cancer 2019 Part 1 – Implementation of Study Results of Novel Study Designs in Clinical Practice in Patients with Early Breast Cancer

Quantitative mathematical objective evaluation of contrast-enhanced spectral mammogram in the assessment of response to neoadjuvant chemotherapy and prediction of residual disease in breast cancer

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