Abstract
With the improvement of neoadjuvant chemotherapy (NAC), the proportion of pathological complete response (pCR) in the breast and axillary lymph node (ALN) is increasing. The evaluation of pCR does not include the status of internal mammary lymph node (IMLN). This study is to evaluate the roles of both axillary sentinel lymph node biopsy (ASLNB) and internal mammary sentinel lymph node biopsy (IM-SLNB) in breast cancer patients after NAC. There were 74 patients enrolled into this study. IM-SLNB was performed on patients with radioactive internal mammary sentinel lymph node (IM-SLN). Patients (n = 8) with cN0 and ycN0 received ASLNB, and axillary lymph node dissection (ALND) in cases of positive axillary sentinel lymph node (ASLN). Patients (n = 48) with cN+ but ycN0 received ASLNB and ALND. Patients (n = 18) with ycN+ received ALND without ASLNB. The visualization rate of IM-SLN was 56.8% (42/74). The success rate of IM-SLNB was 97.6% (41/42) and the metastasis rate of IM-SLN was 7.3% (3/41). The success rate of ASLNB was 100% (56/56). The false negative rate (FNR) of ASLNB was 17.2% (5/29). The FNR in patients with 1, 2 and ≥ 3ASLNs examined was 27.3% (3/11), 20.0% (2/10) and 0% (0/8) respectively. ASLNB could be performed on ycN0 after NAC, and ALND should be performed on initially ALN-positive patients. IM-SLNB should be considered after NAC, especially for patients with clinically positive axillary nodes before NAC, which might help make clear of the pathological nodal staging of both ALN and IMLN, improve the definition of nodal pCR, and guide the individual adjuvant regional and systemic therapy.
Highlights
Neoadjuvant chemotherapy (NAC) has become the standard therapy for both locally advanced and early-stage breast cancer in recent years for the improvement breastconserving surgery rate and the evaluation of treatment response in vivo [1, 2]
Definition of Pathological complete response (pCR) has changed from eradication of tumor in the breast alone to both the breast and lymph nodes, which was better associated with improved event-free survival and overall survival and indicated the importance of the pathological status of axillary lymph node (ALN) [1, 2]
This study is to evaluate the roles of both internal mammary sentinel lymph node biopsy (IM-SLNB) and Axillary sentinel lymph node biopsy (ASLNB) in breast cancer patients after NAC
Summary
Neoadjuvant chemotherapy (NAC) has become the standard therapy for both locally advanced and early-stage breast cancer in recent years for the improvement breastconserving surgery rate and the evaluation of treatment response in vivo [1, 2]. Axillary sentinel lymph node biopsy (ASLNB) has replaced axillary lymph node dissection (ALND) as the standard axillary nodal staging technique for patients with clinically node-negative (cN0) breast cancer [4]. The application of ASLNB for axillary staging after NAC on those who initially had node-positive (cN+) breast cancer is uncertain due to the high false-negative rate (FNR) reported in previous studies [5, 6]. An increase of pCR rate did not predict improved survival rate absolutely, maybe it is related to that previous studies only evaluated the pathological status of ALN without internal mammary www.impactjournals.com/oncotarget lymph node (IMLN) condition. This study is to evaluate the roles of both internal mammary sentinel lymph node biopsy (IM-SLNB) and ASLNB in breast cancer patients after NAC
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
