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

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