SENTINA (SENTinel NeoAdjuvant) Study

• The SENTINA (SENTinel NeoAdjuvant) study:
  • Was designed to evaluate the optimum timing of sentinel node biopsy (SNB) for breast cancer patients treated with neoadjuvant chemotherapy (NAC)

• SENTINA Trial:
  • Was a four-arm, prospective, multicenter cohort study of 1,737 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 (Arm A):
  • If the sentinel node (SN) was positive:
    • A second SNB and axillary lymph node dissection (ALND) was performed after NAC (Arm B)
• Women who were clinically node positive (cN+) underwent NAC, and those who converted to being cN- also had SNB and axillary lymph node dissection (Arm C)
• Only patients whose clinical nodal status remained positive (ycN1) underwent axillary dissection without sentinel lymph node biopsy (arm D)
• 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 3 or more lymph nodes removed and if both blue dye and radiocolloid were used
        • In these cases, the FNR was 8.6%
• References
  • Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, 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(7):609-618.
  • Schwentner L, Helms G, Nekljudova V, Ataseven B, Bauerfeind I, Ditsch N, et al. Using ultrasound and palpation for predicting axillary lymph node status following neoadjuvant chemotherapy – Results from the multi-center SENTINA trial. Breast. 2017;31:202-207.

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