Sentinel Lymph Node (SLN) Biopsy following Neoadjuvant Chemotherapy (NACT) for early stage breast cancer
Association of Breast Surgery ePoster Library. Taher W. 05/15/17; 166196; P148
Wafa Taher
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Abstract
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Introduction
Nodal downstaging following NACT can potentially avoid 'obligatory' axillary lymph node dissection (ALND) in many patients. Performance of SLN biopsy in the context of NACT is reviewed since changing from an upfront pre-NACT approach.
Methods
A retrospective analysis was undertaken of 56 patients undergoing mastectomy (n = 19) or conservation surgery (n= 37) plus SLN biopsy following NACT for breast cancer (T1-3; N0). All patients were clinically node negative with a normal axillary ultrasound examination or a negative axillary core biopsy at presentation. SLN localisation employed radioisotope alone (29), blue dye alone (1) or a combination (26).
Results
The average number of SLNs removed was 2 (range 1 – 6) with identification rates of 100%. Six patients had macrometastases (n=3) or micrometastases (n=3) yielding a node positivity rate of 11% (6/56). Two-thirds of these patients (4/6) had neither tumour nor fibrosis in non-sentinel lymph nodes whilst 2 patients had residual disease (≤2mm). One-quarter of patients (15/56) had one SLN removed and half ≥3 nodes. There was no relationship between number of nodes harvested and node positivity rates with fibrosis seen in a single node only. Overall breast pCR rate was 66% (37/56).
Conclusion
SLN biopsy is safe and accurate post-NACT and is associated with a halving of node positivity rates compared with historical rates of 27% for an upfront approach in the same breast unit. This may relate partially to nodal downstaging but could also reflect improved selection of patients for primary ALND from image-guided needle biopsy of axillary nodes.
Nodal downstaging following NACT can potentially avoid 'obligatory' axillary lymph node dissection (ALND) in many patients. Performance of SLN biopsy in the context of NACT is reviewed since changing from an upfront pre-NACT approach.
Methods
A retrospective analysis was undertaken of 56 patients undergoing mastectomy (n = 19) or conservation surgery (n= 37) plus SLN biopsy following NACT for breast cancer (T1-3; N0). All patients were clinically node negative with a normal axillary ultrasound examination or a negative axillary core biopsy at presentation. SLN localisation employed radioisotope alone (29), blue dye alone (1) or a combination (26).
Results
The average number of SLNs removed was 2 (range 1 – 6) with identification rates of 100%. Six patients had macrometastases (n=3) or micrometastases (n=3) yielding a node positivity rate of 11% (6/56). Two-thirds of these patients (4/6) had neither tumour nor fibrosis in non-sentinel lymph nodes whilst 2 patients had residual disease (≤2mm). One-quarter of patients (15/56) had one SLN removed and half ≥3 nodes. There was no relationship between number of nodes harvested and node positivity rates with fibrosis seen in a single node only. Overall breast pCR rate was 66% (37/56).
Conclusion
SLN biopsy is safe and accurate post-NACT and is associated with a halving of node positivity rates compared with historical rates of 27% for an upfront approach in the same breast unit. This may relate partially to nodal downstaging but could also reflect improved selection of patients for primary ALND from image-guided needle biopsy of axillary nodes.
Introduction
Nodal downstaging following NACT can potentially avoid 'obligatory' axillary lymph node dissection (ALND) in many patients. Performance of SLN biopsy in the context of NACT is reviewed since changing from an upfront pre-NACT approach.
Methods
A retrospective analysis was undertaken of 56 patients undergoing mastectomy (n = 19) or conservation surgery (n= 37) plus SLN biopsy following NACT for breast cancer (T1-3; N0). All patients were clinically node negative with a normal axillary ultrasound examination or a negative axillary core biopsy at presentation. SLN localisation employed radioisotope alone (29), blue dye alone (1) or a combination (26).
Results
The average number of SLNs removed was 2 (range 1 – 6) with identification rates of 100%. Six patients had macrometastases (n=3) or micrometastases (n=3) yielding a node positivity rate of 11% (6/56). Two-thirds of these patients (4/6) had neither tumour nor fibrosis in non-sentinel lymph nodes whilst 2 patients had residual disease (≤2mm). One-quarter of patients (15/56) had one SLN removed and half ≥3 nodes. There was no relationship between number of nodes harvested and node positivity rates with fibrosis seen in a single node only. Overall breast pCR rate was 66% (37/56).
Conclusion
SLN biopsy is safe and accurate post-NACT and is associated with a halving of node positivity rates compared with historical rates of 27% for an upfront approach in the same breast unit. This may relate partially to nodal downstaging but could also reflect improved selection of patients for primary ALND from image-guided needle biopsy of axillary nodes.
Nodal downstaging following NACT can potentially avoid 'obligatory' axillary lymph node dissection (ALND) in many patients. Performance of SLN biopsy in the context of NACT is reviewed since changing from an upfront pre-NACT approach.
Methods
A retrospective analysis was undertaken of 56 patients undergoing mastectomy (n = 19) or conservation surgery (n= 37) plus SLN biopsy following NACT for breast cancer (T1-3; N0). All patients were clinically node negative with a normal axillary ultrasound examination or a negative axillary core biopsy at presentation. SLN localisation employed radioisotope alone (29), blue dye alone (1) or a combination (26).
Results
The average number of SLNs removed was 2 (range 1 – 6) with identification rates of 100%. Six patients had macrometastases (n=3) or micrometastases (n=3) yielding a node positivity rate of 11% (6/56). Two-thirds of these patients (4/6) had neither tumour nor fibrosis in non-sentinel lymph nodes whilst 2 patients had residual disease (≤2mm). One-quarter of patients (15/56) had one SLN removed and half ≥3 nodes. There was no relationship between number of nodes harvested and node positivity rates with fibrosis seen in a single node only. Overall breast pCR rate was 66% (37/56).
Conclusion
SLN biopsy is safe and accurate post-NACT and is associated with a halving of node positivity rates compared with historical rates of 27% for an upfront approach in the same breast unit. This may relate partially to nodal downstaging but could also reflect improved selection of patients for primary ALND from image-guided needle biopsy of axillary nodes.
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