Nodal positivity in patients with clinically and radiologically node-negative breast cancer treated with neoadjuvant chemotherapy: multicentre collaborative study
The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopatholo...
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| Veröffentlicht in: | British journal of surgery 2024-01, Vol.111 (1) |
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| creator | Zaborowski, Alexandra M Doogan, Katie Clifford, Siobhan Dowling, Gavin Kazi, Farah Delaney, Karina Yadav, Himanshu Brady, Aaron Geraghty, James Evoy, Denis Rothwell, Jane McCartan, Damian Heeney, Anna Barry, Mitchel Walsh, Siun M Stokes, Maurice Kell, Malcolm R Allen, Michael Power, Colm Hill, Arnold D K Connolly, Elizabeth Alazawi, Dhafir Boyle, Terence Corrigan, Mark O'Leary, Peter Prichard, Ruth S |
| description | The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopathological features associated with lymph node metastasis after neoadjuvant chemotherapy (ypN+).
A retrospective multicentre study was performed. Patients with cT1-3 cN0 breast cancer who underwent sentinel lymph node biopsy after neoadjuvant chemotherapy between 2016 and 2021 were included. Negative nodal status was defined as the absence of palpable lymph nodes, and the absence of suspicious nodes on axillary ultrasonography, or the absence of tumour cells on axillary nodal fine needle aspiration or core biopsy.
A total of 371 patients were analysed. Overall, 47 patients (12.7%) had a positive sentinel lymph node biopsy. Nodal positivity was identified in 22 patients (29.0%) with hormone receptor+/human epidermal growth factor receptor 2- tumours, 12 patients (13.8%) with hormone receptor+/human epidermal growth factor receptor 2+ tumours, 3 patients (5.6%) with hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 10 patients (6.5%) with triple-negative breast cancer. Multivariable logistic regression analysis showed that multicentric disease was associated with a higher likelihood of ypN+ (OR 2.66, 95% c.i. 1.18 to 6.01; P = 0.018), whilst a radiological complete response in the breast was associated with a reduced likelihood of ypN+ (OR 0.10, 95% c.i. 0.02 to 0.42; P = 0.002), regardless of molecular subtype. Only 3% of patients who had a radiological complete response in the breast were ypN+. The majority of patients (85%) with a positive sentinel node proceeded to axillary lymph node dissection and 93% had N1 disease.
The rate of sentinel lymph node positivity in patients who achieve a radiological complete response in the breast is exceptionally low for all molecular subtypes. |
| doi_str_mv | 10.1093/bjs/znad401 |
| format | Article |
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A retrospective multicentre study was performed. Patients with cT1-3 cN0 breast cancer who underwent sentinel lymph node biopsy after neoadjuvant chemotherapy between 2016 and 2021 were included. Negative nodal status was defined as the absence of palpable lymph nodes, and the absence of suspicious nodes on axillary ultrasonography, or the absence of tumour cells on axillary nodal fine needle aspiration or core biopsy.
A total of 371 patients were analysed. Overall, 47 patients (12.7%) had a positive sentinel lymph node biopsy. Nodal positivity was identified in 22 patients (29.0%) with hormone receptor+/human epidermal growth factor receptor 2- tumours, 12 patients (13.8%) with hormone receptor+/human epidermal growth factor receptor 2+ tumours, 3 patients (5.6%) with hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 10 patients (6.5%) with triple-negative breast cancer. Multivariable logistic regression analysis showed that multicentric disease was associated with a higher likelihood of ypN+ (OR 2.66, 95% c.i. 1.18 to 6.01; P = 0.018), whilst a radiological complete response in the breast was associated with a reduced likelihood of ypN+ (OR 0.10, 95% c.i. 0.02 to 0.42; P = 0.002), regardless of molecular subtype. Only 3% of patients who had a radiological complete response in the breast were ypN+. The majority of patients (85%) with a positive sentinel node proceeded to axillary lymph node dissection and 93% had N1 disease.
The rate of sentinel lymph node positivity in patients who achieve a radiological complete response in the breast is exceptionally low for all molecular subtypes.</description><identifier>ISSN: 1365-2168</identifier><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1093/bjs/znad401</identifier><identifier>PMID: 38055888</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Axilla - pathology ; Breast Neoplasms - diagnostic imaging ; Breast Neoplasms - drug therapy ; Breast Neoplasms - pathology ; Female ; Hormones - therapeutic use ; Humans ; Lymph Node Excision ; Lymph Nodes - diagnostic imaging ; Lymph Nodes - pathology ; Neoadjuvant Therapy ; Original ; Sentinel Lymph Node Biopsy ; Triple Negative Breast Neoplasms - diagnostic imaging ; Triple Negative Breast Neoplasms - drug therapy ; Triple Negative Breast Neoplasms - pathology</subject><ispartof>British journal of surgery, 2024-01, Vol.111 (1)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c346t-928c79a0c261c793f23ea2ff695b8b52d73eee932695ddc8e3ab28c74528a4d73</citedby><orcidid>0000-0002-0894-4079</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38055888$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zaborowski, Alexandra M</creatorcontrib><creatorcontrib>Doogan, Katie</creatorcontrib><creatorcontrib>Clifford, Siobhan</creatorcontrib><creatorcontrib>Dowling, Gavin</creatorcontrib><creatorcontrib>Kazi, Farah</creatorcontrib><creatorcontrib>Delaney, Karina</creatorcontrib><creatorcontrib>Yadav, Himanshu</creatorcontrib><creatorcontrib>Brady, Aaron</creatorcontrib><creatorcontrib>Geraghty, James</creatorcontrib><creatorcontrib>Evoy, Denis</creatorcontrib><creatorcontrib>Rothwell, Jane</creatorcontrib><creatorcontrib>McCartan, Damian</creatorcontrib><creatorcontrib>Heeney, Anna</creatorcontrib><creatorcontrib>Barry, Mitchel</creatorcontrib><creatorcontrib>Walsh, Siun M</creatorcontrib><creatorcontrib>Stokes, Maurice</creatorcontrib><creatorcontrib>Kell, Malcolm R</creatorcontrib><creatorcontrib>Allen, Michael</creatorcontrib><creatorcontrib>Power, Colm</creatorcontrib><creatorcontrib>Hill, Arnold D K</creatorcontrib><creatorcontrib>Connolly, Elizabeth</creatorcontrib><creatorcontrib>Alazawi, Dhafir</creatorcontrib><creatorcontrib>Boyle, Terence</creatorcontrib><creatorcontrib>Corrigan, Mark</creatorcontrib><creatorcontrib>O'Leary, Peter</creatorcontrib><creatorcontrib>Prichard, Ruth S</creatorcontrib><title>Nodal positivity in patients with clinically and radiologically node-negative breast cancer treated with neoadjuvant chemotherapy: multicentre collaborative study</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopathological features associated with lymph node metastasis after neoadjuvant chemotherapy (ypN+).
A retrospective multicentre study was performed. Patients with cT1-3 cN0 breast cancer who underwent sentinel lymph node biopsy after neoadjuvant chemotherapy between 2016 and 2021 were included. Negative nodal status was defined as the absence of palpable lymph nodes, and the absence of suspicious nodes on axillary ultrasonography, or the absence of tumour cells on axillary nodal fine needle aspiration or core biopsy.
A total of 371 patients were analysed. Overall, 47 patients (12.7%) had a positive sentinel lymph node biopsy. Nodal positivity was identified in 22 patients (29.0%) with hormone receptor+/human epidermal growth factor receptor 2- tumours, 12 patients (13.8%) with hormone receptor+/human epidermal growth factor receptor 2+ tumours, 3 patients (5.6%) with hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 10 patients (6.5%) with triple-negative breast cancer. Multivariable logistic regression analysis showed that multicentric disease was associated with a higher likelihood of ypN+ (OR 2.66, 95% c.i. 1.18 to 6.01; P = 0.018), whilst a radiological complete response in the breast was associated with a reduced likelihood of ypN+ (OR 0.10, 95% c.i. 0.02 to 0.42; P = 0.002), regardless of molecular subtype. Only 3% of patients who had a radiological complete response in the breast were ypN+. The majority of patients (85%) with a positive sentinel node proceeded to axillary lymph node dissection and 93% had N1 disease.
The rate of sentinel lymph node positivity in patients who achieve a radiological complete response in the breast is exceptionally low for all molecular subtypes.</description><subject>Axilla - pathology</subject><subject>Breast Neoplasms - diagnostic imaging</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - pathology</subject><subject>Female</subject><subject>Hormones - therapeutic use</subject><subject>Humans</subject><subject>Lymph Node Excision</subject><subject>Lymph Nodes - diagnostic imaging</subject><subject>Lymph Nodes - pathology</subject><subject>Neoadjuvant Therapy</subject><subject>Original</subject><subject>Sentinel Lymph Node Biopsy</subject><subject>Triple Negative Breast Neoplasms - diagnostic imaging</subject><subject>Triple Negative Breast Neoplasms - drug therapy</subject><subject>Triple Negative Breast Neoplasms - pathology</subject><issn>1365-2168</issn><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkU1v1DAQhq0K1JbCiTvykUuoY8dZpxeEKr6kCi7tOZrYs7teOXZqO1uFn8Mvxe0uqJw8M-_M887IhLyt2YeadeJy2KXLXx5Mw-oTcl6LVla8btWLZ_EZeZXSjrFaMMlPyZlQTEql1Dn5_SMYcHQKyWa7t3mh1tMJskWfE32weUu1s95qcG6h4A2NYGxwYXMs-WCw8rgpI3ukQ0RImWrwGiPNJctoDhiPAcxu3oMv-hbHkLcYYVqu6Di7bHUxjEh1cA6GEA-4lGezvCYv1-ASvjm-F-Tuy-fb62_Vzc-v368_3VRaNG2uOq70qgOmeVuXQKy5QODrddvJQQ2Sm5VAxE7wUjBGKxQwPI40kitoinpBPh640zyMaJ4WAtdP0Y4Qlz6A7f9XvN32m7Dva7ZqheRdIbw_EmK4nzHlfrRJY7moHD-nnquuEyveyqa0vntu9s_l78-IPxgGl5g</recordid><startdate>20240103</startdate><enddate>20240103</enddate><creator>Zaborowski, Alexandra M</creator><creator>Doogan, Katie</creator><creator>Clifford, Siobhan</creator><creator>Dowling, Gavin</creator><creator>Kazi, Farah</creator><creator>Delaney, Karina</creator><creator>Yadav, Himanshu</creator><creator>Brady, Aaron</creator><creator>Geraghty, James</creator><creator>Evoy, Denis</creator><creator>Rothwell, Jane</creator><creator>McCartan, Damian</creator><creator>Heeney, Anna</creator><creator>Barry, Mitchel</creator><creator>Walsh, Siun M</creator><creator>Stokes, Maurice</creator><creator>Kell, Malcolm R</creator><creator>Allen, Michael</creator><creator>Power, Colm</creator><creator>Hill, Arnold D K</creator><creator>Connolly, Elizabeth</creator><creator>Alazawi, Dhafir</creator><creator>Boyle, Terence</creator><creator>Corrigan, Mark</creator><creator>O'Leary, Peter</creator><creator>Prichard, Ruth S</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0894-4079</orcidid></search><sort><creationdate>20240103</creationdate><title>Nodal positivity in patients with clinically and radiologically node-negative breast cancer treated with neoadjuvant chemotherapy: multicentre collaborative study</title><author>Zaborowski, Alexandra M ; Doogan, Katie ; Clifford, Siobhan ; Dowling, Gavin ; Kazi, Farah ; Delaney, Karina ; Yadav, Himanshu ; Brady, Aaron ; Geraghty, James ; Evoy, Denis ; Rothwell, Jane ; McCartan, Damian ; Heeney, Anna ; Barry, Mitchel ; Walsh, Siun M ; Stokes, Maurice ; Kell, Malcolm R ; Allen, Michael ; Power, Colm ; Hill, Arnold D K ; Connolly, Elizabeth ; Alazawi, Dhafir ; Boyle, Terence ; Corrigan, Mark ; O'Leary, Peter ; Prichard, Ruth S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c346t-928c79a0c261c793f23ea2ff695b8b52d73eee932695ddc8e3ab28c74528a4d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Axilla - pathology</topic><topic>Breast Neoplasms - diagnostic imaging</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - pathology</topic><topic>Female</topic><topic>Hormones - therapeutic use</topic><topic>Humans</topic><topic>Lymph Node Excision</topic><topic>Lymph Nodes - diagnostic imaging</topic><topic>Lymph Nodes - pathology</topic><topic>Neoadjuvant Therapy</topic><topic>Original</topic><topic>Sentinel Lymph Node Biopsy</topic><topic>Triple Negative Breast Neoplasms - diagnostic imaging</topic><topic>Triple Negative Breast Neoplasms - drug therapy</topic><topic>Triple Negative Breast Neoplasms - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zaborowski, Alexandra M</creatorcontrib><creatorcontrib>Doogan, Katie</creatorcontrib><creatorcontrib>Clifford, Siobhan</creatorcontrib><creatorcontrib>Dowling, Gavin</creatorcontrib><creatorcontrib>Kazi, Farah</creatorcontrib><creatorcontrib>Delaney, Karina</creatorcontrib><creatorcontrib>Yadav, Himanshu</creatorcontrib><creatorcontrib>Brady, Aaron</creatorcontrib><creatorcontrib>Geraghty, James</creatorcontrib><creatorcontrib>Evoy, Denis</creatorcontrib><creatorcontrib>Rothwell, Jane</creatorcontrib><creatorcontrib>McCartan, Damian</creatorcontrib><creatorcontrib>Heeney, Anna</creatorcontrib><creatorcontrib>Barry, Mitchel</creatorcontrib><creatorcontrib>Walsh, Siun M</creatorcontrib><creatorcontrib>Stokes, Maurice</creatorcontrib><creatorcontrib>Kell, Malcolm R</creatorcontrib><creatorcontrib>Allen, Michael</creatorcontrib><creatorcontrib>Power, Colm</creatorcontrib><creatorcontrib>Hill, Arnold D K</creatorcontrib><creatorcontrib>Connolly, Elizabeth</creatorcontrib><creatorcontrib>Alazawi, Dhafir</creatorcontrib><creatorcontrib>Boyle, Terence</creatorcontrib><creatorcontrib>Corrigan, Mark</creatorcontrib><creatorcontrib>O'Leary, Peter</creatorcontrib><creatorcontrib>Prichard, Ruth S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zaborowski, Alexandra M</au><au>Doogan, Katie</au><au>Clifford, Siobhan</au><au>Dowling, Gavin</au><au>Kazi, Farah</au><au>Delaney, Karina</au><au>Yadav, Himanshu</au><au>Brady, Aaron</au><au>Geraghty, James</au><au>Evoy, Denis</au><au>Rothwell, Jane</au><au>McCartan, Damian</au><au>Heeney, Anna</au><au>Barry, Mitchel</au><au>Walsh, Siun M</au><au>Stokes, Maurice</au><au>Kell, Malcolm R</au><au>Allen, Michael</au><au>Power, Colm</au><au>Hill, Arnold D K</au><au>Connolly, Elizabeth</au><au>Alazawi, Dhafir</au><au>Boyle, Terence</au><au>Corrigan, Mark</au><au>O'Leary, Peter</au><au>Prichard, Ruth S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nodal positivity in patients with clinically and radiologically node-negative breast cancer treated with neoadjuvant chemotherapy: multicentre collaborative study</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2024-01-03</date><risdate>2024</risdate><volume>111</volume><issue>1</issue><issn>1365-2168</issn><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopathological features associated with lymph node metastasis after neoadjuvant chemotherapy (ypN+).
A retrospective multicentre study was performed. Patients with cT1-3 cN0 breast cancer who underwent sentinel lymph node biopsy after neoadjuvant chemotherapy between 2016 and 2021 were included. Negative nodal status was defined as the absence of palpable lymph nodes, and the absence of suspicious nodes on axillary ultrasonography, or the absence of tumour cells on axillary nodal fine needle aspiration or core biopsy.
A total of 371 patients were analysed. Overall, 47 patients (12.7%) had a positive sentinel lymph node biopsy. Nodal positivity was identified in 22 patients (29.0%) with hormone receptor+/human epidermal growth factor receptor 2- tumours, 12 patients (13.8%) with hormone receptor+/human epidermal growth factor receptor 2+ tumours, 3 patients (5.6%) with hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 10 patients (6.5%) with triple-negative breast cancer. Multivariable logistic regression analysis showed that multicentric disease was associated with a higher likelihood of ypN+ (OR 2.66, 95% c.i. 1.18 to 6.01; P = 0.018), whilst a radiological complete response in the breast was associated with a reduced likelihood of ypN+ (OR 0.10, 95% c.i. 0.02 to 0.42; P = 0.002), regardless of molecular subtype. Only 3% of patients who had a radiological complete response in the breast were ypN+. The majority of patients (85%) with a positive sentinel node proceeded to axillary lymph node dissection and 93% had N1 disease.
The rate of sentinel lymph node positivity in patients who achieve a radiological complete response in the breast is exceptionally low for all molecular subtypes.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>38055888</pmid><doi>10.1093/bjs/znad401</doi><orcidid>https://orcid.org/0000-0002-0894-4079</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE |
| subjects | Axilla - pathology Breast Neoplasms - diagnostic imaging Breast Neoplasms - drug therapy Breast Neoplasms - pathology Female Hormones - therapeutic use Humans Lymph Node Excision Lymph Nodes - diagnostic imaging Lymph Nodes - pathology Neoadjuvant Therapy Original Sentinel Lymph Node Biopsy Triple Negative Breast Neoplasms - diagnostic imaging Triple Negative Breast Neoplasms - drug therapy Triple Negative Breast Neoplasms - pathology |
| title | Nodal positivity in patients with clinically and radiologically node-negative breast cancer treated with neoadjuvant chemotherapy: multicentre collaborative study |
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