Sentinel Lymph Node Biopsy (SLNB) in Patients Undergoing Neoadjuvant Chemotherapy – Pre or Post Treatment? Part II

• Retrospective studies of SLN biopsy validated by ALND:
  • Show that the success rate of SLN biopsy after neoadjuvant chemotherapy is:
    • About 90%:
      • Somewhat less than for SLN biopsy overall
  • The false-negative rate is about 10%:
    • Comparable to SLN biopsy overall)
• For patients with proven nodal metastases:
  • The prospective American College of Surgeons Oncology Group (ACOSOG) Z1071 and SENTinel NeoAdjuvant (SENTINA) trial:
    • Observe success rates of:
      • 85% to 90%:
        • False-negative rates of :
          • 12% to 14% for SLN biopsy
    • In both studies the false-negative rate was minimized:
      • By dual-agent mapping (dye plus isotope) and the removal of greater than 2 SLN
    • These results suggest that ALND may not be required for node-positive patients postchemotherapy when a technically satisfactory SLN biopsy is negative:
      • Patients with any positive axillary nodes postchemotherapy require ALND and are at increased risk of locoregional recurrence.
• A new trial:
  • Alliance 11202 is randomizing node-positive patients whose SLN remain positive after neoadjuvant chemotherapy to:
    • ALND / RT versus RT alone

• REFERENCES
  1. Alliance for Clinical Trials in Oncology. www.allianceforclinicaltrialsinoncology.org. Accessed January 18, 2017.
  2. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310:1455-1461.
  3. Houssami N, Macaskill P, von Minckwitz G, et al. Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer. 2012;48:3342-3354.
  4. Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14:609-618.
  5. Mamounas EP, Anderson SJ, Dignam JJ, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 2012;30:3960-3966.
  6. Mauri D, Pavlidis N, Ioannidis JPA. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:188-194.
  7. van Deurzen CH, Vriens BE, Tjan-Heijnen VC, et al. Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients: a systematic review. Eur J Cancer. 2009;45:3124-3130.

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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