Premium
Timing of sentinel lymph node biopsy in patients receiving neoadjuvant chemotherapy for breast cancer
Author(s) -
Papa Moshe Zvi,
Zippel Douglas,
Kaufman Bella,
ShimonPaluch Shani,
Yosepovich Ady,
Oberman Bernice,
Sadetzki Siegal
Publication year - 2008
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21128
Subject(s) - medicine , sentinel lymph node , breast cancer , axillary lymph node dissection , axilla , lumpectomy , biopsy , neoadjuvant therapy , mastectomy , surgery , chemotherapy , cancer , oncology , radiology
Objective To address optimal timing of sentinel lymph node biopsy (SLNB) in breast cancer patients undergoing neoadjuvant treatment. Methods The study population included 117 patients with locally advanced cancer with clinically negative nodes treated with primary chemotherapy. Group 1 underwent SLNB and completion axillary lymph node dissection (ALND) in conjunction with lumpectomy/mastectomy, after neoadjuvant treatment (n = 31). Group 2 underwent SLNB followed by neoadjuvant therapy and subsequently surgery and completion of ALNDs (n = 58). Group 3 was treated using the same sequence as group 2, however, completion ALND was performed only for patients with positive sentinel lymph nodes (SLNs) (n = 28). Results SLN identification was lowest in group 1 compared to groups 2 and 3 (87% and 98.8% respectively; P = <0.05). The highest false negative rate was in group 1 (15.8% compared with 0% in group 2). Conclusion Neoadjuvant treatment lowers the SLN identification rate, possibly due to fibrosis within the axilla, and increases the false negative rate due to downstaging. SLN biopsy prior to chemotherapy could give a more accurate evaluation of axillary status, unaffected by any previous therapeutic intervention. J. Surg. Oncol. © 2008 Wiley‐Liss, Inc.