• SENTINA Trial:
    • Was a 4-arm, prospective, multicenter cohort study:
      • Of 1,737 patients:
        • That evaluated the role of sentinel lymph node biopsy (SLNB) in patients who had undergone neoadjuvant chemotherapy (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 SLNB before NAC (Arm A)
      • If the sentinel node (SN) was positive:
        • A second SLNB 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 SLNB 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 SLNB 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 SLNB 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 SLNB prior to chemotherapy and 88% in those who converted from cN+ to cN- with NAC and had only one SLNB
  • For patients who were confirmed node positive by SLNB biopsy prior to NAC:
    • The FNR of repeat SLNB after NAC was 51.6%
  • For patients who converted from cN+ to cN- with NAC:
    • FNR of SLNB 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.
#Arrangoiz #CancerSurgeon #BreastSurgeon #MSMC #MountSiniaMedicalCenter #Miami #Mexico

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