SENTINA Trial

• SENTINA:
  • Was a four arm, prospective, multicenter cohort study of 1737 patients
  • To evaluate the role of SNB in patients who had undergone NAC for invasive breast cancer
  • Clinical node status was determined by palpation and ultrasound in all patients
  • Ultrasound guided fine-needle aspiration or core biopsy:
    • Was recommended but not mandatory
  • Patients with clinically node-negative (cN-) disease:
    • Underwent SNB before NAC:
      • If the sentinel node SN was positive:
        • A second SNB and axillary lymph node dissection (ALND) was performed after NAC
  • Women who were clinically node positive (cN+) underwent NAC, and those who converted to being cN-:
    • Also had SNB and axillary lymph node dissection
  • When SNB was done before NAC:
    • No difference in the detection rate was found:
      • Between the combined (radiocolloid and blue dye) and single agent (radiocolloid alone) detection techniques:
        • 99.5% vs 98.8%
    • However:
      • When SNB was done after NAC:
        • The addition of blue dye:
          • Increased the detection rate and
          • The number of nodes retrieved
      • Dual tracer detection rate:
        • Was 76% after chemotherapy in patients who also had SNB prior to chemotherapy
        • 88% in those who converted from cN+ to cN- with NAC and had only one SNB
• For patients who were confirmed node positive by SNB biopsy prior to NAC:
  • The FNR of repeat SNB after NAC was 51.6%
• For patients who converted from cN+ to cN- with NAC:
  • FNR of SNB after NAC was 14.2%:
    • However, in the cN+ to cN- group:
      • The FNR was below 10%, for patients who had:
        • Three or more lymph nodes removed and if both blue dye and radiocolloid were used:
          • In these cases, the FNR was 8.6%

REFERENCES

1. 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.

#Arrangoiz #Surgeon #BreastSurgeon #Teacher #BreastCancer #SurgicaoOncologist