The success of sentinel lymph node biopsy after neoadjuvant therapy: A single institution review

Am J Surg. 2017 Dec;214(6):1096-1101. doi: 10.1016/j.amjsurg.2017.08.024. Epub 2017 Sep 18.

Abstract

Background: The appropriate management of the axilla among women undergoing neoadjuvant therapy is in evolution.

Method: A retrospective review of a prospective database of women with breast cancer who underwent neoadjuvant systemic therapy using endocrine/chemotherapy (NE/CT) from 2002 to 2015 was performed.

Results: We reviewed 253 women: triple negative breast cancer (30%), ER+HER2- (44%) breast cancer and HER2+ (25%) disease. The mean age was 55 years (SD = 12). 197 patients were analyzed based on their axillary disease. 33 patients (35%) who had clinical N1-3 disease prior to neoadjuvant therapy had no axillary metastases at definitive surgery. There were no significant differences in overall survival or local/regional recurrence between patients who underwent axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), or SLNB+ALND (p = 0.05061 and p = 0.33).

Conclusion: SLNB is a viable technique in patients with breast cancer undergoing NE/CT. Patients with pre-neoadjuvant therapy proven axillary disease may be a candidate for SLNB as opposed to planned ALND with good multidisciplinary review of their response and localization of previously positive lymph nodes.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Axilla
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery*
  • Female
  • Humans
  • Lymph Node Excision
  • Middle Aged
  • Neoadjuvant Therapy*
  • Neoplasm Staging
  • Retrospective Studies
  • Sentinel Lymph Node Biopsy*
  • Survival Rate
  • Treatment Outcome