Abstract
Background
There is no evidence that supports the recommendation of sentinel lymph node biopsy
(SLNB) in patients with breast cancer who have treated with neoadjuvant chemotherapy
(NAC) to downsize tumors in order to allow breast conservation surgery, because NAC
induces anatomical alterations of the lymphatic drainage. We evaluated the effectiveness
of SLNB using intraoperative one-step nucleic acid amplification (OSNA) method to
detect microscopic metastases or isolated tumor cells after NAC in patients with clinically
negative axillary nodes at initial presentation.
Patients and methods
We evaluated in patients with breast cancer and clinically negative axilla at presentation,
the effectiveness of SLNB by OSNA after NAC (71 patients) or prior to NAC (40 patients).
Results
The rate of SLN identification was 100% in both groups. 17 women with SLNB prior to
systemic treatment showed positive nodes (14 macrometastases and 3 micrometastases),
and positive SLNB were detected in 15 women with SLNB after NAC, which were 14 macrometastases
and 1 micrometastase. The negative predictive value of ultrasonography was 57.5% in
patients with SLNB prior to neoadjuvant therapy and 78.9% in patients with chemotherapy
followed by SLNB.
Conclusions
Intraoperative SLNB using OSNA in women with clinically negative axillary lymph nodes
at initial presentation who received NAC could predict axillary status with high accuracy.
Also it allows us to take decisions about the indication or not to perform an axillary
dissection at the moment, thus avoiding delay in the administration of chemotherapy
and benefiting the patients from a single surgical procedure.
Keywords
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Article info
Publication history
Accepted:
May 2,
2013
Identification
Copyright
© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
