- 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
- If the sentinel node SN was positive:
- Underwent SNB before 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%
- Between the combined (radiocolloid and blue dye) and single agent (radiocolloid alone) detection techniques:
- However:
- When SNB was done after NAC:
- The addition of blue dye:
- Increased the detection rate and
- The number of nodes retrieved
- The addition of blue dye:
- 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
- When SNB was done after NAC:
- No difference in the detection rate was found:
- 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%
- Three or more lymph nodes removed and if both blue dye and radiocolloid were used:
- The FNR was below 10%, for patients who had:
- However, in the cN+ to cN- group:
- FNR of SNB after NAC was 14.2%:
REFERENCES
- 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.
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