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Intraoperative sentinel node biopsy by one-step nucleic acid amplification (OSNA) avoids axillary lymphadenectomy in women with breast cancer treated with neoadjuvant chemotherapy

  • J. Navarro-Cecilia
    Affiliations
    Breast Pathology Unit, Department of Surgery, Hospital Complex of Jaén, Av. Ejército Español, 10, Jaén 23 007, Spain
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  • B. Dueñas-Rodríguez
    Affiliations
    Breast Pathology Unit, Department of Surgery, Hospital Complex of Jaén, Av. Ejército Español, 10, Jaén 23 007, Spain

    Experimental and Clinical Physiopathology Research Group BIO296, School of Experimental Sciences, Department of Health Sciences, Campus Universitario Las Lagunillas, University of Jaén, Jaén E23 071, Spain
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  • C. Luque-López
    Affiliations
    Breast Pathology Unit, Department of Surgery, Hospital Complex of Jaén, Av. Ejército Español, 10, Jaén 23 007, Spain
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  • M.J. Ramírez-Expósito
    Affiliations
    Experimental and Clinical Physiopathology Research Group BIO296, School of Experimental Sciences, Department of Health Sciences, Campus Universitario Las Lagunillas, University of Jaén, Jaén E23 071, Spain
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  • J. Martínez-Ferrol
    Affiliations
    Experimental and Clinical Physiopathology Research Group BIO296, School of Experimental Sciences, Department of Health Sciences, Campus Universitario Las Lagunillas, University of Jaén, Jaén E23 071, Spain

    Department of Radiology, Hospital Complex of Jaén, Av. Ejército Español, 10, Jaén 23 007, Spain
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  • A. Ruíz-Mateas
    Affiliations
    Department of Pathologic Anatomy, Hospital Complex of Jaén, Av. Ejército Español, 10, Jaén 23 007, Spain
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  • C. Ureña
    Affiliations
    Breast Pathology Unit, Department of Surgery, Hospital Complex of Jaén, Av. Ejército Español, 10, Jaén 23 007, Spain
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  • M.P. Carrera-González
    Affiliations
    Experimental and Clinical Physiopathology Research Group BIO296, School of Experimental Sciences, Department of Health Sciences, Campus Universitario Las Lagunillas, University of Jaén, Jaén E23 071, Spain
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  • M.D. Mayas
    Affiliations
    Experimental and Clinical Physiopathology Research Group BIO296, School of Experimental Sciences, Department of Health Sciences, Campus Universitario Las Lagunillas, University of Jaén, Jaén E23 071, Spain
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  • J.M. Martínez-Martos
    Correspondence
    Corresponding author. Tel.: +34 953 21 26 00; fax: +34 953 21 29 43.
    Affiliations
    Experimental and Clinical Physiopathology Research Group BIO296, School of Experimental Sciences, Department of Health Sciences, Campus Universitario Las Lagunillas, University of Jaén, Jaén E23 071, Spain
    Search for articles by this author

      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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