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

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  • Axillary SLNB:
    • Remains the standard of care in the staging of clinically node-negative patients,:
      • And is endorsed in the 2014 update of the American Society of Clinical Oncology clinical practice guidelines.
  • For patients undergoing neoadjuvant chemotherapy:
    • The optimal timing of SLNB (pre- or postchemotherapy) is debated:
      • Concerns regarding performance of SLNB after neoadjuvant chemotherapy:
        • Have historically centered around the ability to both identify a sentinel node and the sensitivity of the SLNB to predict non-SLN involvement:
          • Particularly among clinically node-positive patients:
            • Whose lymphatic pathways may be occluded by tumor and/or scarring resultant from chemotherapy.
        • However, over the past 10 years, a number of prospective studies have shown:
          • high accuracy of SLNB in the postneoadjuvant setting in patients presenting as clinically node negative prior to receiving neoadjuvant chemotherapy.
        • Proponents of SLNB subsequent to neoadjuvant chemotherapy tout the fact that:
          • This spares the patient another surgical procedure and that SLN posttreatment is more meaningful for predicting prognosis.
        • In a small, early study published in 2000:
          • 51 patients (postneoadjuvant chemotherapy) underwent SLNB followed by completion ALND:
            • SLN identification rate was high at 94%
            • The false-negative rate was low at 5.8%
        • In 2008, the Austrian Sentinel Node Study group published their results on 167 neoadjuvant chemotherapy patients who underwent postchemotherapy SLNB followed by completion ALND:
          • SLNB was only offered to those with clinically negative nodes after chemotherapy
          • SLN identification rate was:
            • Highest with use of both vital blue dye and radiocolloid:
              • 88% identification with dual tracer
            • False-negative rate of the SLNB was:
              • Only 8%
        • In the larger, multicenter National Surgical Adjuvant Breast and Bowel Project (NSABP) B-27 trial:
          • 428 patients underwent SLNB before a required ALND
          • Successful identification of a SLN was again high:
            • 89% if radiocolloid was used:
              • The 10% false-negative rate comparable to the rate observed for prechemotherapy SLNB in multicenter studies
        • If SLNB is performed and the SLN(s) is positive prior to neoadjuvant chemotherapy:
          • A SLNB should not be repeated subsequent to chemotherapy:
            • The large, multicenter SENTinel NeoAdjuvant (SENTINA) trial:
              • Arm B demonstrated that in this setting, identification rates were:
                • Low (61%)
                • False-negative rates unacceptably high (52%)

👉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

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

  • References:
    1. Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol. 2000;18:3480-3486.
    2. 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.
    3. Mamounas EP, Brown A, Anderson S, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2005;23:2694-2702.
    4. Tan VKM, Goh BKP, Fook-Chong S, et al.The feasibility and accuracy of sentinel lymph node biopsy in clinically node-negative patients after neoadjuvant chemotherapy for breast cancer—a systematic review and meta-analysis. J Surg Oncol. 2011;104:97-103.
    5. Tausch C, Konstantiniuk P, Kugler F, et al; Austrian Sentinel Node Study Group. Sentinel lymph node biopsy after preoperative chemotherapy for breast cancer: findings from the Austrian Sentinel Node Study Group. Ann Sur Oncol. 2008;15:3378-3383.
    6. 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.
    7. Xing Y, Foy M, Cox DD, et al. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg. 2006;93:539-546.

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