Intraoperative assessment of sentinel lymph nodes after neoadjuvant chemotherapy in patients with breast cancer.

BACKGROUND: Sentinel lymph node (SLN) biopsy has been shown to be both accurate and feasible for women who receive neoadjuvant chemotherapy (NAC). This study was designed to evaluate the ability of intraoperative assessment to predict metastasis in the sentinel node after NAC and to compare it with patients not treated with NAC. METHODS: Thirty-seven patients with invasive breast cancer and SLN biopsy after NAC and 461 patients with invasive breast cancer not treated with NAC were included in the study. The SLN was identified by the gamma probe and sent to pathology for frozen (FS) and H&E paraffin-sections. If the SLN was negative by H&E paraffin-sections, then immunohistochemistry was performed. RESULTS: The sensitivity of FS in the NAC group ranged from 78.5% for micro and isolated tumor cells to 100% for macrometastasis. The sensitivity of FS in the non-NAC group ranged from 82% for micro and isolated tumor cells to 97.4% for macrometastasis. There were no statistically differences between the sensitivities of FS in the two groups. Nine (64.2%) of the 14 patients in the NAC group with metastasis to the SLN had other non-SLN metastasis. CONCLUSIONS: After NAC, FS is an effective method for detecting macrometastasis in the SLN. As in the adjuvant setting, the sensitivity of FS is lower for SLN micro and sub-micrometastasis. Intraoperative FS of the SLN after NAC is indicated to avoid a second surgery because 60% of patients with a positive SLN will have additional positive axillary nodes.

Palladium catalyzed amination of vinyl chlorides: a new entry to imines, enamines and 2-amino-1,3-butadienes.

Vinyl chlorides are employed for the first time in palladium catalyzed cross-coupling reactions with amines to furnish imines and enamines. The new methodology has been applied to the synthesis of 2-amino-1,3-butadienes, that could not be achieved from the corresponding bromides.

Solid-phase synthesis of polysubstituted piperidines by imino-Diels-Alder cycloaddition of 2-amino-1,3-butadienes with solid-supported imines.

[reaction: see text] The solid-phase imino-Diels-Alder reaction of 2-amino-1,3-butadienes with solid-supported imines is described. The reaction furnishes 4-piperidones and 4-aminopiperidines with high diastereoselectivity and with very good yields and purity after the release from the solid support. The possibility of introducing variations in both cycloaddition partners gives rise to substituted piperidines with up to five elements of diversity.