Swedish prospective multicenter trial evaluating sentinel lymph node biopsy after neoadjuvant systemic therapy in clinically node-positive breast cancer
| Autor: | Fuat Celebioglu, L. Zetterlund, Jan Frisell, Athanasios Zouzos, Thomas Hatschek, Rimma Axelsson, Jana de Boniface |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Oncology Node-positive Cancer Research medicine.medical_specialty medicine.medical_treatment Sentinel lymph node Neoadjuvant systemic therapy Breast Neoplasms 030230 surgery Sensitivity and Specificity 03 medical and health sciences Breast cancer 0302 clinical medicine Sentinel lymph node biopsy Internal medicine Multicenter trial Biopsy medicine Humans Anthracyclines Prospective Studies Prospective cohort study Mastectomy Neoadjuvant therapy Aged Aged 80 and over Sweden medicine.diagnostic_test Aromatase Inhibitors business.industry Middle Aged medicine.disease Clinical Trial Neoadjuvant Therapy Axilla medicine.anatomical_structure Lymphatic Metastasis Identification rate 030220 oncology & carcinogenesis Lymph Node Excision Female Taxoids False-negative rate business |
| Zdroj: | Breast Cancer Research and Treatment |
| ISSN: | 1573-7217 0167-6806 |
| Popis: | Purpose Patients with clinically node-positive breast cancer planned for neoadjuvant systemic therapy (NAST) may draw advantages from the nodal downstaging effect and reduce the extent of axillary surgery with sentinel lymph node biopsy (SLNB) performed after NAST. Since there are concerns about lower sentinel lymph node (SLN) detection and higher false-negative rates (FNR) in this setting, our aim was to define the accuracy of SLNB after NAST. Methods This Swedish national multicenter trial prospectively recruited 195 breast cancer patients from ten hospitals with T1–T4d biopsy-proven node-positive disease planned for NAST between October 1, 2010 and December 31, 2015. Clinically node-negative axillary status after NAST was not mandatory. SLNB was always attempted and followed by a completion axillary lymph node dissection (ALND). Results The SLN identification rate was 77.9% (152/195) but improved to 80.7% (138/171) with dual mapping. The median number of SLNs was two (range 1–5). A positive SLNB was found in 52% (79/152), almost 66% (52/79) of whom had additional positive non-sentinel lymph nodes. The overall pathologic nodal response rate was 33.3% (66/195). The overall FNR was 14.1% (13/92) but decreased to 4% (2/50) when only patients with two or more sentinel nodes were analyzed. Conclusions In biopsy-proven node-positive breast cancer, SLNB after NAST is feasible even though the identification rate is lower than in clinically node-negative patients. Since the overall FNR is unacceptably high, the omission of ALND should only be considered if two or more SLNs are identified. |
| Databáze: | OpenAIRE |
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