Abstract
Simple SummaryThis Propensity Score Matched Analysis aimed to assess the efficacy of superparamagnetic iron oxide (SPIO) and radioisotope sentinel lymph node biopsy (SNLB) in breast cancer (BC) patients after neoadjuvant chemotherapy (NAC). One hundred and twenty-four patients were eligible for final analysis. In the SPIO group, the median of retrieved sentinel lymph nodes (SLNs) was significantly higher than in the RI group. The SPIO method was associated with a significantly higher chance of retrieving at least three SLNs when compared to the RI method. SPIO-guided SLNB allows efficient retrieval and detection of SLNs in BC patients after NAC when compared to RI.The standard method for nodal staging in breast cancer (BC) patients after neoadjuvant chemotherapy (NAC) is sentinel lymph node biopsy (SLNB) with a radioisotope (RI) injection. However, SLNB after NAC results in high false-negative rates (FNR), and the RI method is restricted by nuclear medicine unit dependency. These limitations resulted in the development of the superparamagnetic iron oxide (SPIO) method, reducing FNR and presenting a comparable detection rate. This bi-institutional cohort comparison study aimed to assess the efficacy of SPIO and radioisotope SNLB in BC patients after NAC using Propensity Score Matching (PSM) analysis. The study group comprised 508 patients who underwent SLNB after NAC for ycT1-4N0M0 BC between 2013 and 2021 in two high volume centers. Data were retrieved from prospectively conducted databases. In the SPIO group, the median of retrieved sentinel lymph nodes (SLNs) was significantly higher than in the RI group (3 vs. 2; p < 0.0001). The SPIO method was associated with a significantly higher chance of retrieving at least three lymph nodes when compared to the RI method (71% vs. 11.3%; p < 0.0001). None of the analyzed demographic and clinical variables had a statistically significant influence on the efficacy of SLNs retrieval in the RI group, while in the SPIO group, patients with ≥three harvested SLNs had lower weight and decreased BMI. Based on this PSM analysis, SPIO-guided SLNB allowed the efficient retrieval and detection of SLNs in BC patients after NAC compared to RI.
Highlights
Sentinel lymph node biopsy (SLNB) is an established procedure for clinically negative nodes in early breast cancer (BC) [1,2]
superparamagnetic iron oxide (SPIO) method was associated with a significant, over 19-fold higher chance of retrieving at least three sentinel lymph nodes (SLNs) when compared to the RI method (71% vs. 11.3%; OR = 19.21; 95% CI: 7.36–50.10; p < 0.0001)
Our results indicate that retrieved and evaluated SLNs’ median was significantly higher in the SPIO group
Summary
Sentinel lymph node biopsy (SLNB) is an established procedure for clinically negative nodes (cN0) in early breast cancer (BC) [1,2]. One of the factors restricting proper axillary mapping after neoadjuvant therapy includes the alteration of the lymphatic drainage due to fibrosis and obstruction of lymphatic vessels or the apoptosis of tumor cells [6]. For this reason, SLNB after NAC results in false-negative rates (FNR) varying from 10 to 30%, as shown in the SENTINA trial [7]. The current standard for nodal staging in BC patients after NAC is a radioisotope (RI) SLNB This method contains disadvantages such as nuclear medicine unit dependency or radiation exposure [8]. The existing drawbacks resulted in new, non-radioactive methods of sentinel lymph node (SLN)
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