How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study
Background In breast cancer patients with nodal metastases at presentation, false-negative rates lower than 10 % have been demonstrated for sentinel node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) when three or more negative sentinel nodes (SLNs) are retrieved. However, the frequency with wh...
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| Veröffentlicht in: | Annals of surgical oncology 2016-10, Vol.23 (11), p.3467-3474 |
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| creator | Mamtani, Anita Barrio, Andrea V. King, Tari A. Van Zee, Kimberly J. Plitas, George Pilewskie, Melissa El-Tamer, Mahmoud Gemignani, Mary L. Heerdt, Alexandra S. Sclafani, Lisa M. Sacchini, Virgilio Cody, Hiram S. Patil, Sujata Morrow, Monica |
| description | Background
In breast cancer patients with nodal metastases at presentation, false-negative rates lower than 10 % have been demonstrated for sentinel node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) when three or more negative sentinel nodes (SLNs) are retrieved. However, the frequency with which axillary dissection (ALND) can be avoided is uncertain.
Methods
Among 534 prospectively identified consecutive patients with clinical stages 2 and 3 cancer receiving NAC from November 2013 to November 2015, all biopsy-proven node-positive (N+) cases were identified. Patients clinically node-negative after NAC were eligible for SLNB. The indications for ALND were failed mapping, fewer than three SLNs retrieved, and positive SLNs.
Results
Of 288 N+ patients, 195 completed surgery, with 132 (68 %) of these patients eligible for SLNB. The median age was 50 years. Of these patients, 73 (55 %) were estrogen receptor-positive (ER+), 21 (16 %) were ER− and human epidermal growth factor receptor-2-positive (HER2+), and 38 (29 %) were triple-negative. In four cases, SLNB was deferred intraoperatively. Among 128 SLNB attempts, three or more SLNs were retrieved in 110 cases (86 %), one or two SLNs were retrieved in 15 cases (12 %), and failed mapping occurred in three cases (2 %). In 66 cases, ALND was indicated: 54 (82 %) for positive SLNs, 9 (14 %) for fewer than three negative SLNs, and 3 (4 %) for failed mapping. Persistent disease was found in 17 % of the patients with fewer than three negative SLNs retrieved. Of the 128 SLNB cases, 62 (48 %) had SLNB alone with three or more SLNs retrieved. Among 195 N+ patients who completed surgery, nodal pathologic complete response (pCR) was achieved for 49 %, with rates ranging from 21 % for ER+/HER2− to 97 % for ER−/HER2+ cases, and was significantly more common than breast pCR in ER+/HER2− and triple-negative cases.
Conclusions
Nearly 70 % of the N+ patients were eligible for SLNB after NAC. For 48 %, ALND was avoided, supporting the role of NAC in reducing the need for ALND among patients presenting with nodal metastases. |
| doi_str_mv | 10.1245/s10434-016-5246-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5070651</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4318372171</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-1c6ed0b22939dcc779437cd9235fd23e93fc045e176e51bc556141e244c40ba23</originalsourceid><addsrcrecordid>eNp1UV1vEzEQtBCIlsAP4AVZ4oWXA6_P9t29gKIUCFJpKz7Eo-X49hJHl3OwfWnzX_ixOEqpChKSJVve2dmZHUKeA3sNXMg3EZgoRcFAFZILVdQPyCnI_CNUDQ_zm6m6aLiSJ-RJjGvGoCqZfExOeAWKSV6fkl9zf00vu4QDPfMY6QV6067HnRkSna1w49MKg9nu6XTnXUunN67vTdjTMxcj2uT8QN1Ar0xyOKRIf7i0onMXk-_90lnT93s680PnwgZbeuFb09PPmEzMB-M7-gXj2Oc-31FDr4KP2wPpDunXNLb7p-RRZ_qIz27vCfn-4f232bw4v_z4aTY9L6yoWCrAKmzZgvOmbFprq6oRZWXbhpeya3mJTdlZJiRCpVDCwkqpQAByIaxgC8PLCXl75N2Oi6zTZivB9Hob3CZ71d44_XdlcCu99DstWcWUhEzw6pYg-J8jxqQ3LlrMqxrQj1FDDUrxBurDrJf_QNd-DEO2l1FVmdOCLH9C4IiyeScxYHcnBpg-ZK-P2eucvT5kr-vc8-K-i7uOP2FnAD8CYi4NSwz3Rv-X9Tdc4rzY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1873926194</pqid></control><display><type>article</type><title>How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Mamtani, Anita ; Barrio, Andrea V. ; King, Tari A. ; Van Zee, Kimberly J. ; Plitas, George ; Pilewskie, Melissa ; El-Tamer, Mahmoud ; Gemignani, Mary L. ; Heerdt, Alexandra S. ; Sclafani, Lisa M. ; Sacchini, Virgilio ; Cody, Hiram S. ; Patil, Sujata ; Morrow, Monica</creator><creatorcontrib>Mamtani, Anita ; Barrio, Andrea V. ; King, Tari A. ; Van Zee, Kimberly J. ; Plitas, George ; Pilewskie, Melissa ; El-Tamer, Mahmoud ; Gemignani, Mary L. ; Heerdt, Alexandra S. ; Sclafani, Lisa M. ; Sacchini, Virgilio ; Cody, Hiram S. ; Patil, Sujata ; Morrow, Monica</creatorcontrib><description>Background
In breast cancer patients with nodal metastases at presentation, false-negative rates lower than 10 % have been demonstrated for sentinel node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) when three or more negative sentinel nodes (SLNs) are retrieved. However, the frequency with which axillary dissection (ALND) can be avoided is uncertain.
Methods
Among 534 prospectively identified consecutive patients with clinical stages 2 and 3 cancer receiving NAC from November 2013 to November 2015, all biopsy-proven node-positive (N+) cases were identified. Patients clinically node-negative after NAC were eligible for SLNB. The indications for ALND were failed mapping, fewer than three SLNs retrieved, and positive SLNs.
Results
Of 288 N+ patients, 195 completed surgery, with 132 (68 %) of these patients eligible for SLNB. The median age was 50 years. Of these patients, 73 (55 %) were estrogen receptor-positive (ER+), 21 (16 %) were ER− and human epidermal growth factor receptor-2-positive (HER2+), and 38 (29 %) were triple-negative. In four cases, SLNB was deferred intraoperatively. Among 128 SLNB attempts, three or more SLNs were retrieved in 110 cases (86 %), one or two SLNs were retrieved in 15 cases (12 %), and failed mapping occurred in three cases (2 %). In 66 cases, ALND was indicated: 54 (82 %) for positive SLNs, 9 (14 %) for fewer than three negative SLNs, and 3 (4 %) for failed mapping. Persistent disease was found in 17 % of the patients with fewer than three negative SLNs retrieved. Of the 128 SLNB cases, 62 (48 %) had SLNB alone with three or more SLNs retrieved. Among 195 N+ patients who completed surgery, nodal pathologic complete response (pCR) was achieved for 49 %, with rates ranging from 21 % for ER+/HER2− to 97 % for ER−/HER2+ cases, and was significantly more common than breast pCR in ER+/HER2− and triple-negative cases.
Conclusions
Nearly 70 % of the N+ patients were eligible for SLNB after NAC. For 48 %, ALND was avoided, supporting the role of NAC in reducing the need for ALND among patients presenting with nodal metastases.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-016-5246-8</identifier><identifier>PMID: 27160528</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Axilla ; Breast Neoplasms - drug therapy ; Breast Neoplasms - metabolism ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Breast Oncology ; Chemotherapy, Adjuvant ; Female ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Oncology ; Prospective Studies ; Receptor, ErbB-2 - metabolism ; Receptors, Estrogen - metabolism ; Receptors, Progesterone - metabolism ; Sentinel Lymph Node - pathology ; Sentinel Lymph Node - surgery ; Sentinel Lymph Node Biopsy ; Surgery ; Surgical Oncology ; Triple Negative Breast Neoplasms - pathology ; Triple Negative Breast Neoplasms - surgery</subject><ispartof>Annals of surgical oncology, 2016-10, Vol.23 (11), p.3467-3474</ispartof><rights>Society of Surgical Oncology 2016</rights><rights>Annals of Surgical Oncology is a copyright of Springer, 2016.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-1c6ed0b22939dcc779437cd9235fd23e93fc045e176e51bc556141e244c40ba23</citedby><cites>FETCH-LOGICAL-c470t-1c6ed0b22939dcc779437cd9235fd23e93fc045e176e51bc556141e244c40ba23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-016-5246-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-016-5246-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27160528$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mamtani, Anita</creatorcontrib><creatorcontrib>Barrio, Andrea V.</creatorcontrib><creatorcontrib>King, Tari A.</creatorcontrib><creatorcontrib>Van Zee, Kimberly J.</creatorcontrib><creatorcontrib>Plitas, George</creatorcontrib><creatorcontrib>Pilewskie, Melissa</creatorcontrib><creatorcontrib>El-Tamer, Mahmoud</creatorcontrib><creatorcontrib>Gemignani, Mary L.</creatorcontrib><creatorcontrib>Heerdt, Alexandra S.</creatorcontrib><creatorcontrib>Sclafani, Lisa M.</creatorcontrib><creatorcontrib>Sacchini, Virgilio</creatorcontrib><creatorcontrib>Cody, Hiram S.</creatorcontrib><creatorcontrib>Patil, Sujata</creatorcontrib><creatorcontrib>Morrow, Monica</creatorcontrib><title>How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
In breast cancer patients with nodal metastases at presentation, false-negative rates lower than 10 % have been demonstrated for sentinel node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) when three or more negative sentinel nodes (SLNs) are retrieved. However, the frequency with which axillary dissection (ALND) can be avoided is uncertain.
Methods
Among 534 prospectively identified consecutive patients with clinical stages 2 and 3 cancer receiving NAC from November 2013 to November 2015, all biopsy-proven node-positive (N+) cases were identified. Patients clinically node-negative after NAC were eligible for SLNB. The indications for ALND were failed mapping, fewer than three SLNs retrieved, and positive SLNs.
Results
Of 288 N+ patients, 195 completed surgery, with 132 (68 %) of these patients eligible for SLNB. The median age was 50 years. Of these patients, 73 (55 %) were estrogen receptor-positive (ER+), 21 (16 %) were ER− and human epidermal growth factor receptor-2-positive (HER2+), and 38 (29 %) were triple-negative. In four cases, SLNB was deferred intraoperatively. Among 128 SLNB attempts, three or more SLNs were retrieved in 110 cases (86 %), one or two SLNs were retrieved in 15 cases (12 %), and failed mapping occurred in three cases (2 %). In 66 cases, ALND was indicated: 54 (82 %) for positive SLNs, 9 (14 %) for fewer than three negative SLNs, and 3 (4 %) for failed mapping. Persistent disease was found in 17 % of the patients with fewer than three negative SLNs retrieved. Of the 128 SLNB cases, 62 (48 %) had SLNB alone with three or more SLNs retrieved. Among 195 N+ patients who completed surgery, nodal pathologic complete response (pCR) was achieved for 49 %, with rates ranging from 21 % for ER+/HER2− to 97 % for ER−/HER2+ cases, and was significantly more common than breast pCR in ER+/HER2− and triple-negative cases.
Conclusions
Nearly 70 % of the N+ patients were eligible for SLNB after NAC. For 48 %, ALND was avoided, supporting the role of NAC in reducing the need for ALND among patients presenting with nodal metastases.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Axilla</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - metabolism</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Breast Oncology</subject><subject>Chemotherapy, Adjuvant</subject><subject>Female</subject><subject>Humans</subject><subject>Lymph Node Excision</subject><subject>Lymphatic Metastasis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Oncology</subject><subject>Prospective Studies</subject><subject>Receptor, ErbB-2 - metabolism</subject><subject>Receptors, Estrogen - metabolism</subject><subject>Receptors, Progesterone - metabolism</subject><subject>Sentinel Lymph Node - pathology</subject><subject>Sentinel Lymph Node - surgery</subject><subject>Sentinel Lymph Node Biopsy</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Triple Negative Breast Neoplasms - pathology</subject><subject>Triple Negative Breast Neoplasms - surgery</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1UV1vEzEQtBCIlsAP4AVZ4oWXA6_P9t29gKIUCFJpKz7Eo-X49hJHl3OwfWnzX_ixOEqpChKSJVve2dmZHUKeA3sNXMg3EZgoRcFAFZILVdQPyCnI_CNUDQ_zm6m6aLiSJ-RJjGvGoCqZfExOeAWKSV6fkl9zf00vu4QDPfMY6QV6067HnRkSna1w49MKg9nu6XTnXUunN67vTdjTMxcj2uT8QN1Ar0xyOKRIf7i0onMXk-_90lnT93s680PnwgZbeuFb09PPmEzMB-M7-gXj2Oc-31FDr4KP2wPpDunXNLb7p-RRZ_qIz27vCfn-4f232bw4v_z4aTY9L6yoWCrAKmzZgvOmbFprq6oRZWXbhpeya3mJTdlZJiRCpVDCwkqpQAByIaxgC8PLCXl75N2Oi6zTZivB9Hob3CZ71d44_XdlcCu99DstWcWUhEzw6pYg-J8jxqQ3LlrMqxrQj1FDDUrxBurDrJf_QNd-DEO2l1FVmdOCLH9C4IiyeScxYHcnBpg-ZK-P2eucvT5kr-vc8-K-i7uOP2FnAD8CYi4NSwz3Rv-X9Tdc4rzY</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Mamtani, Anita</creator><creator>Barrio, Andrea V.</creator><creator>King, Tari A.</creator><creator>Van Zee, Kimberly J.</creator><creator>Plitas, George</creator><creator>Pilewskie, Melissa</creator><creator>El-Tamer, Mahmoud</creator><creator>Gemignani, Mary L.</creator><creator>Heerdt, Alexandra S.</creator><creator>Sclafani, Lisa M.</creator><creator>Sacchini, Virgilio</creator><creator>Cody, Hiram S.</creator><creator>Patil, Sujata</creator><creator>Morrow, Monica</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20161001</creationdate><title>How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study</title><author>Mamtani, Anita ; Barrio, Andrea V. ; King, Tari A. ; Van Zee, Kimberly J. ; Plitas, George ; Pilewskie, Melissa ; El-Tamer, Mahmoud ; Gemignani, Mary L. ; Heerdt, Alexandra S. ; Sclafani, Lisa M. ; Sacchini, Virgilio ; Cody, Hiram S. ; Patil, Sujata ; Morrow, Monica</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-1c6ed0b22939dcc779437cd9235fd23e93fc045e176e51bc556141e244c40ba23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Axilla</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - metabolism</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Breast Oncology</topic><topic>Chemotherapy, Adjuvant</topic><topic>Female</topic><topic>Humans</topic><topic>Lymph Node Excision</topic><topic>Lymphatic Metastasis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Oncology</topic><topic>Prospective Studies</topic><topic>Receptor, ErbB-2 - metabolism</topic><topic>Receptors, Estrogen - metabolism</topic><topic>Receptors, Progesterone - metabolism</topic><topic>Sentinel Lymph Node - pathology</topic><topic>Sentinel Lymph Node - surgery</topic><topic>Sentinel Lymph Node Biopsy</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Triple Negative Breast Neoplasms - pathology</topic><topic>Triple Negative Breast Neoplasms - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mamtani, Anita</creatorcontrib><creatorcontrib>Barrio, Andrea V.</creatorcontrib><creatorcontrib>King, Tari A.</creatorcontrib><creatorcontrib>Van Zee, Kimberly J.</creatorcontrib><creatorcontrib>Plitas, George</creatorcontrib><creatorcontrib>Pilewskie, Melissa</creatorcontrib><creatorcontrib>El-Tamer, Mahmoud</creatorcontrib><creatorcontrib>Gemignani, Mary L.</creatorcontrib><creatorcontrib>Heerdt, Alexandra S.</creatorcontrib><creatorcontrib>Sclafani, Lisa M.</creatorcontrib><creatorcontrib>Sacchini, Virgilio</creatorcontrib><creatorcontrib>Cody, Hiram S.</creatorcontrib><creatorcontrib>Patil, Sujata</creatorcontrib><creatorcontrib>Morrow, Monica</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mamtani, Anita</au><au>Barrio, Andrea V.</au><au>King, Tari A.</au><au>Van Zee, Kimberly J.</au><au>Plitas, George</au><au>Pilewskie, Melissa</au><au>El-Tamer, Mahmoud</au><au>Gemignani, Mary L.</au><au>Heerdt, Alexandra S.</au><au>Sclafani, Lisa M.</au><au>Sacchini, Virgilio</au><au>Cody, Hiram S.</au><au>Patil, Sujata</au><au>Morrow, Monica</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>23</volume><issue>11</issue><spage>3467</spage><epage>3474</epage><pages>3467-3474</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
In breast cancer patients with nodal metastases at presentation, false-negative rates lower than 10 % have been demonstrated for sentinel node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) when three or more negative sentinel nodes (SLNs) are retrieved. However, the frequency with which axillary dissection (ALND) can be avoided is uncertain.
Methods
Among 534 prospectively identified consecutive patients with clinical stages 2 and 3 cancer receiving NAC from November 2013 to November 2015, all biopsy-proven node-positive (N+) cases were identified. Patients clinically node-negative after NAC were eligible for SLNB. The indications for ALND were failed mapping, fewer than three SLNs retrieved, and positive SLNs.
Results
Of 288 N+ patients, 195 completed surgery, with 132 (68 %) of these patients eligible for SLNB. The median age was 50 years. Of these patients, 73 (55 %) were estrogen receptor-positive (ER+), 21 (16 %) were ER− and human epidermal growth factor receptor-2-positive (HER2+), and 38 (29 %) were triple-negative. In four cases, SLNB was deferred intraoperatively. Among 128 SLNB attempts, three or more SLNs were retrieved in 110 cases (86 %), one or two SLNs were retrieved in 15 cases (12 %), and failed mapping occurred in three cases (2 %). In 66 cases, ALND was indicated: 54 (82 %) for positive SLNs, 9 (14 %) for fewer than three negative SLNs, and 3 (4 %) for failed mapping. Persistent disease was found in 17 % of the patients with fewer than three negative SLNs retrieved. Of the 128 SLNB cases, 62 (48 %) had SLNB alone with three or more SLNs retrieved. Among 195 N+ patients who completed surgery, nodal pathologic complete response (pCR) was achieved for 49 %, with rates ranging from 21 % for ER+/HER2− to 97 % for ER−/HER2+ cases, and was significantly more common than breast pCR in ER+/HER2− and triple-negative cases.
Conclusions
Nearly 70 % of the N+ patients were eligible for SLNB after NAC. For 48 %, ALND was avoided, supporting the role of NAC in reducing the need for ALND among patients presenting with nodal metastases.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>27160528</pmid><doi>10.1245/s10434-016-5246-8</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Annals of surgical oncology, 2016-10, Vol.23 (11), p.3467-3474 |
| issn | 1068-9265 1534-4681 |
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| subjects | Adult Aged Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols - therapeutic use Axilla Breast Neoplasms - drug therapy Breast Neoplasms - metabolism Breast Neoplasms - pathology Breast Neoplasms - surgery Breast Oncology Chemotherapy, Adjuvant Female Humans Lymph Node Excision Lymphatic Metastasis Medicine Medicine & Public Health Middle Aged Neoadjuvant Therapy Neoplasm Staging Oncology Prospective Studies Receptor, ErbB-2 - metabolism Receptors, Estrogen - metabolism Receptors, Progesterone - metabolism Sentinel Lymph Node - pathology Sentinel Lymph Node - surgery Sentinel Lymph Node Biopsy Surgery Surgical Oncology Triple Negative Breast Neoplasms - pathology Triple Negative Breast Neoplasms - surgery |
| title | How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study |
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