Sentinel lymph node biopsy in patients with locally advanced breast cancer after neoadjuvant chemotherapy.

PURPOSE: To check the rate of sentinel lymph node (SLN) identification in patients with locally advanced breast cancer who underwent neoadjuvant chemotherapy comparing intraoperative contact cytology (imprint) and embedded in paraffin and validation of methods. METHODS: A cross-sectional validation of diagnostic test involving 34 patients from the outpatient clinic of the Maternity School Assis Chateaubriand. The patients had locally advanced breast cancer and were treated with neoadjuvant chemotherapy. Those with clinically negative axilla underwent SLN biopsy, studied by imprint and histopathology in paraffin. All patients underwent axillary dissection and its histopathological study. RESULTS: The SLN identification rate was 85.3% (29/34). The sensitivity of imprint associated with paraffin on detection of metastasis compared to histopathology of the axillary content was 84.62% and specificity of 100% with false-negative rate of 12.01% and an accuracy of 92.77%. CONCLUSION: The search for metastases in the SLN by imprint and histopathological analysis in paraffin compared to the gold standard (axillary dissection) had a low sensitivity with high rate of false negatives in our sample.

Sentinel lymph node biopsy in patients with locally advanced breast cancer after neoadjuvant chemotherapy / Biopsia do linfonodo sentinela em câncer na mama localmente avançado pós-quimioterapia neoadjuvante

PURPOSE: To check the rate of sentinel lymph node (SLN) identification in patients with locally advanced breast cancer who underwent neoadjuvant chemotherapy comparing intraoperative contact cytology (imprint) and embedded in paraffin and validation of methods. METHODS: A cross-sectional validation of diagnostic test involving 34 patients from the outpatient clinic of the Maternity School Assis Chateaubriand. The patients had locally advanced breast cancer and were treated with neoadjuvant chemotherapy. Those with clinically negative axilla underwent SLN biopsy, studied by imprint and histopathology in paraffin. All patients underwent axillary dissection and its histopathological study. RESULTS: The SLN identification rate was 85.3% (29/34). The sensitivity of imprint associated with paraffin on detection of metastasis compared to histopathology of the axillary content was 84.62% and specificity of 100% with false-negative rate of 12.01% and an accuracy of 92.77%. CONCLUSION: The search for metastases in the SLN by imprint and histopathological analysis in paraffin compared to the gold standard (axillary dissection) had a low sensitivity with high rate of false negatives in our sample.

OBJETIVO: Verificar a taxa de identificação do linfonodo sentinela (LS) em pacientes portadoras de câncer na mama localmente avançado e que foram submetidos à quimioterapia neoadjuvante comparando a citologia de contato intraoperatória (imprint) e a inclusão em parafina e validação dos procedimentos. MÉTODOS: Estudo transversal de validação de teste diagnóstico envolvendo 34 pacientes oriundas do Ambulatório da Maternidade-Escola Assis Chateaubriand. As pacientes eram portadoras de câncer na mama localmente avançado e foram tratadas com quimioterapia neoadjuvante. Àquelas com axila clinicamente negativa foram submetidas à biopsia do LS, esse estudado por impint e histopatologia em parafina. Todas as pacientes foram submetidas a esvaziamento axilar e seu estudo histopatológico. RESULTADOS: A taxa de identificação do LS foi de 85,3% (29/34). A sensibilidade do imprint associada à parafina quanto à detecção de metástase comparado a análise histopatológica do conteúdo axilar foi de 84,62% e a especificidade de 100% com taxa de falso-negativo de 12,01% e acurácia de 92,77%. CONCLUSÃO: A pesquisa de metástases no linfonodo sentinela por imprint e análise histopatológica em parafina quando comparado ao padrão ouro (esvaziamento axilar) apresentou baixa sensibilidade com taxa elevada de falsos negativos em nossa amostra.