9. Studies of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients

Abstract

S 735 of the study will promote a more structured breast cancer surgical care and better patient information service. To our best knowledge, this is the largest related preoperative investigation in the English language literature and the first one in the Central and Eastern European region. 9. Studies of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients T. Kinoshita, T. Hojo, J. Suzuki, K. Jimbo, K. Taruno, S. Asaga, M. Yoshida, H. Tsuda 1 National Cancer Centre Hospital, Surgical Oncology Division, Tokyo, Japan National Cancer Centre Hospital, Pathology Division, Tokyo, Japan Background: Despite the increasing use of both sentinel lymph node biopsy (SLNB) and preoperative chemotherapy (PST) in patients with operable breast cancer, there is still limited information on the feasibility and accuracy of SLNB following PST. In this study, the feasibility and accuracy of SLNB for breast cancer patients with clinically negative lymph nodes after PSTwere investigated. In addition, we evaluated a new automated assay system for cytokeratin 19 mRNA, the one-step nucleic acid amplification (OSNA) assay (Sysmex), to detect lymph node metastasis of breast cancer after PST. Materials and methods: Between 2003 and 2008, 200 patients with Stage II and III breast cancer previously treated with PST were enrolled in this study. The eligible criteria for PST were (a) primary tumor > 3cm or (b) positive axillary lymph node status on initial examination. FNA biopsy was performed for clinically or ultrasonographically suspicious axillary lymph nodes. The patients then underwent SLNB, which involved a combination of intradermal injection over the tumor of radiocolloid and subareolar injection of blue dye. This was followed by Level I/ II axillary lymph node dissection (ALND). Surgically obtained 84 lymph nodes from 21 breast cancer patients received PST were examined with both OSNA assay and HE five hundred & seventy patients of stage I to III breast carcinoma have autologous breast reconstruction with modified extended LDF with added vascularised chest wall fat; 47% had SSM and the remaining had NSM. Age ranges from 23 to 53 years (median 1⁄4 40.5). Results: Subjective patient satisfaction was excellent in 71%, good in 20%, fair in 7% & poor in 2% of cases. Bilateral size & shape symmetry are excellent in 56%, good in 26%, fair in 12% & poor in 6% patient. The overall RT-related complications are 9 %, the most common complications are skin burns (5%) & fat necrosis (4%). Patients are followed for mean follow up of 75.5 months (2-96). Conclusion: Modified extended latissimus dorsi myocutaneous flap with added vascularised chest wall fat is a single stage totally autologous breast reconstruction allows reconstruction without the additional cost of an implant, many complications of synthetic implants, micro vascular procedure second stage surgery or surgical manipulation in the other breast. In addition the overall survival & local recurrence rates were similar to MRM.