Sentinel lymph node biopsy in breast cancer patients positive axillary lymph node after neoadjuvant chemotherapy

Abstract

Objective To explore the feasibility of sentinel lymph node biopsy (SLNB) in breast cancer patients positive in axillary lymph node after neoadjuvant chemotherapy (NAC) . Methods 69 patients with breast cancer treated at our hospital from 2012 to 2014 were retrospectively analyzed. All the patients were confirmed as positive in axillary lymph node by fine needle aspiration cytology or tubular needle biopsy. SLNB was carried out using methylene blue dye after NAC; then axillary lymph node dissection was carried out. All the specimens of lymph nodes were embedded with paraffin and done serial section and HE staining. Results The pathological complete response (PCR) rate of axillary lymph nodes after NAC was 26.06% (18/69) . The detection rate of SLNB was 88.41% (61/69) . The false negative rate was 7.84% (4/51) . The accuracy was 93.44% (57/61) . There were statistical differences in the detection rate (95.34% vs. 76.92%, P=0.021) and false negative rate (2.86% vs. 18.75%, P=0.050) between patients initially in cN1 and in cN2 before NAC. The false negative rates and accuracies in the patients with 1, 2 and ≥3 SLNs were 33.33% and 75%, 33.33% and 66.67%, and 4.44% and 96.30%, with statistical differences (P=0.047, P=0.04) .The detection rate and false negative rate of SLNB has no obvious correlation with primary tumor size, clinical chemotherapy reaction condition, pathological type, and postoperative pathological condition. Conclusions The detection rate and false negative rate of SLNB in patients positive in axillary nodes after NAC are acceptable, so it is considerable to perform SLNB after NAC to confirm the axillary node status and determine whether axillary lymph node need whole resection. Key words: Breast cancer; Neoadjuvant chemotherapy; Sentinel lymph node biopsy