Your browser doesn't support javascript.
loading
Impact of Residual Nodal Disease Burden on Technical Outcomes of Sentinel Lymph Node Biopsy for Node-Positive (cN1) Breast Cancer Patients Treated with Neoadjuvant Chemotherapy.
Laws, Alison; Hughes, Melissa E; Hu, Jiani; Barry, William T; Dominici, Laura; Nakhlis, Faina; Barbie, Thanh; Duggan, Margaret; Weiss, Anna; Rhei, Esther; Carter, Katharine; Nimbkar, Suniti; Schnitt, Stuart J; King, Tari A.
Afiliación
  • Laws A; University of Calgary, Calgary, AB, Canada.
  • Hughes ME; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
  • Hu J; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
  • Barry WT; Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.
  • Dominici L; Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.
  • Nakhlis F; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
  • Barbie T; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
  • Duggan M; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
  • Weiss A; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
  • Rhei E; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
  • Carter K; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
  • Nimbkar S; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
  • Schnitt SJ; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
  • King TA; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
Ann Surg Oncol ; 26(12): 3846-3855, 2019 Nov.
Article en En | MEDLINE | ID: mdl-31222687
ABSTRACT

BACKGROUND:

Recent trials have demonstrated the feasibility of sentinel lymph node biopsy (SLNB) for cN1 breast cancer patients after neoadjuvant chemotherapy (NAC). This study evaluated the technical outcomes of SLNB by residual nodal disease volume.

METHODS:

From a prospective database, cT1-3 cN1 patients receiving NAC and surgery from 2016 to 2017 were identified. Performance measures of post-NAC physical exam and imaging-based axillary assessment were compared. For the patients who converted to cN0 and underwent SLNB, adequate mapping (defined as ≥ 3 SLN) and the false-negative rate (FNR) of intraoperative SLN evaluation were assessed by residual nodal disease volume (ypN1-3 vs ypN0[i+]/ypN1mi vs ypN0).

RESULTS:

Of 156 cT1-3 cN1 patients, 96 converted to cN0 and underwent SLNB. Adequate mapping was achieved for 64 patients (66.7%) and was not associated with nodal volume (p = 0.12). The FNR of the intraoperative SLN evaluation was 37.8%, and smaller nodal volume was associated with FNR (p < 0.01). Of 36 patients (37.5%) who achieved an axillary pathologic complete response, 24 (66.7%) had three or more negative SLNs and were safely spared axillary lymph node dissection (ALND). The positive predictive values of physical exam versus imaging-based post-NAC nodal assessment were respectively 88% and 69.8%.

CONCLUSIONS:

This study showed SLNB to be an effective tool for minimizing axillary surgery in cN1 patients treated with NAC. However, important technical limitations exist, such as inability to identify three SLNs in more than two-thirds of patients and high-false negative rates for intraoperative SLN evaluation, particularly for patients with small residual nodal volumes. Preoperative counseling should include realistic assessment of the potential need for ALND in this population.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Protocolos de Quimioterapia Combinada Antineoplásica / Carcinoma Lobular / Carcinoma Ductal de Mama / Neoplasia Residual / Terapia Neoadyuvante / Biopsia del Ganglio Linfático Centinela Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2019 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Protocolos de Quimioterapia Combinada Antineoplásica / Carcinoma Lobular / Carcinoma Ductal de Mama / Neoplasia Residual / Terapia Neoadyuvante / Biopsia del Ganglio Linfático Centinela Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2019 Tipo del documento: Article País de afiliación: Canadá