Staging of the Axilla in Inflammatory Breast Cancer

  • Sentinel lymph node biopsy:
    • Is the standard of care for the majority of invasive breast cancers:
      • That are clinically node-negative regardless of patient age
  • Locally advanced cancers (T3-T4):
    • Are still considered contraindications to sentinel lymph node biopsy, thus inflammatory cancer (T4d):
      • Makes her only axillary staging option:
        • An axillary lymph node dissection
      • Sentinel node biopsy is prohibited by virtue of the inflammatory diagnosis:
        • As the diagnosis suggests the dermal lymphatics are compromised with tumor
  • While some studies have shown a higher false negative rate in patients undergoing sentinel lymph node biopsy after neo-adjuvant chemotherapy:
    • This does not appear to affect axillary recurrence or survival:
      • Leading to current consensus guidelines that it is safe in this population
  • Several studies have shown that sentinel lymph node biopsy is safe in:
    • Multifocal and multicentric disease.
  • There is no accurate axillary imaging that currently can replace sentinel lymph node biopsy in breast cancer
  • References
  • Lyman GH, Temin S, Edge SB, Newman LA, Turner RR, Weaver DL, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2014;32(13):1365-1383.
  • NCCN Breast Cancer Guidelines 2018. National Comprehensive Cancer Network website. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed October 17, 2019.
  • Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927-933.
  • Mamounas EP, Brown A, Anderson S, Smith R, Julian T, Miller B, Bear HD, 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(12):2694-2702.
  • Geng C, Chen X, Pan X, Li J. The feasibility and accuracy of sentinel lymph node biopsy in initially clinically node-negative breast cancer after neoadjuvant chemotherapy: a systematic review and meta-analysis. PLoS One. 2016;11(9):e0162605.
  • Knauer M, Konstantiniuk P, Haid A, Wenzl E, Riegler-Keil M, Pöstlberger S, et al. Multicentric breast cancer: a new indication for sentinel node biopsy–a multi-institutional validation study. J Clin Oncol.2006;24(21):3374-3380.

#Arrangoiz #BreastCancer #BreastSurgeon #SurgicalOncologist #Miami #InflammatoryBreastCancer #StagingoftheAxilla

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