An AN OBSERVATIONAL STUDY OF SLN MAPPING IN PATIENTS OF LOCALLY ADVANCED BREAST CANCER FOLLOWING NCT

Background : Locally advanced breast carcinoma (LABC) includes a wide range of clinical scenarios- advanced primary tumors (T4), advanced nodal disease and inflammatory carcinomas(1). Traditionally, treatment of LABC included a combination of Chemotherapy, Radiation and Surgery(2). However, there has been a shift to Neoadjuvant Chemotherapy in recent times.(3) Histological status and the number of axillary lymph nodes with metastasis is one of the most important prognostic factors and most powerful predictor of recurrence and survival in patients of breast carcinoma and remains so, even after neo-adjuvant chemotherapy. (3) Information derived from the sentinel lymph node is considered valuable, with less discomfort to the patient when compared with axillary dissection.(4) However, its role in detecting nodal metastasis after neo-adjuvant chemotherapy in LABC is still debatable and definitive studies to evaluate its role are still evolving. (5) Materials and Methods: Patients of LABC were evaluated using ultrasonography (USG) of axilla. Neo-adjuvant chemotherapy (NACT) was administered and patients were reassessed by USG of axilla. Thirty patients with node negative axillary status were subjected to Sentinel lymph node mapping using isosulfan blue followed by Modified Radical Mastectomy and Axillary Lymph Node Dissection. Histopathological evaluation of stained and unstained lymph nodes done and the data, thus obtained, was statistically analysed.   Results: Sentinel lymph node biopsy performed using Isosulfan Blue dye alone, after neo-adjuvant chemotherapy predicts the status of axillary lymph nodes with low accuracy.   Conclusions: Further studies would be required to establish the role of sentinel lymph node biopsy in patients with LABC after NACT.