Sentinel lymph node biopsy in patients with locally advanced breast cancer after neoadjuvant chemotherapy

Paulo Henrique Walter Aguiar,Rosa Maria Salani Mota,João Ivo Xavier Rocha,Nair Hermínia Gurjão Margotti,Luiz Gonzaga Porto Pinheiro

doi:10.1590/s0102-86502012001200014

Paulo Henrique Walter Aguiar, Rosa Maria Salani Mota + Show 3 more

Open Access

https://doi.org/10.1590/s0102-86502012001200014

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Abstract

To check the rate of sentinel lymph node (SLN) identification in patients with locally advanced breast cancer who underwent neoadjuvant chemotherapy comparing intraoperative contact cytology (imprint) and embedded in paraffin and validation of methods. A cross-sectional validation of diagnostic test involving 34 patients from the outpatient clinic of the Maternity School Assis Chateaubriand. The patients had locally advanced breast cancer and were treated with neoadjuvant chemotherapy. Those with clinically negative axilla underwent SLN biopsy, studied by imprint and histopathology in paraffin. All patients underwent axillary dissection and its histopathological study. The SLN identification rate was 85.3% (29/34). The sensitivity of imprint associated with paraffin on detection of metastasis compared to histopathology of the axillary content was 84.62% and specificity of 100% with false-negative rate of 12.01% and an accuracy of 92.77%. The search for metastases in the SLN by imprint and histopathological analysis in paraffin compared to the gold standard (axillary dissection) had a low sensitivity with high rate of false negatives in our sample.

Highlights

In Brazil, breast cancer is the malignancy that causes more deaths among women[1]
Unlike to developed countries where screening mammography showed an impact on overall survival, among us, most cases are diagnosed in an opportunistic way with over 50% in advanced stages of disease, factor that provides a lower rate of curability and higher mutilation[3]
A review study of sentinel lymph node (SLN) biopsy in patients with breast cancer showed an accuracy of 95%, which proposes reliability and safety of the method[4]

Summary

Introduction

In Brazil, breast cancer is the malignancy that causes more deaths among women[1]. There is an increase of their frequency in developed and developing countries, with a 10 times increase in incidence rates according to World Health Organization[2].Unlike to developed countries where screening mammography showed an impact on overall survival, among us, most cases are diagnosed in an opportunistic way with over 50% in advanced stages of disease (clinical stage III and IV), factor that provides a lower rate of curability and higher mutilation[3].A review study of SLN biopsy in patients with breast cancer showed an accuracy of 95%, which proposes reliability and safety of the method[4].The chemotherapy as adjuvant treatment in breast cancer has been used in different settings. Unlike to developed countries where screening mammography showed an impact on overall survival, among us, most cases are diagnosed in an opportunistic way with over 50% in advanced stages of disease (clinical stage III and IV), factor that provides a lower rate of curability and higher mutilation[3]. A review study of SLN biopsy in patients with breast cancer showed an accuracy of 95%, which proposes reliability and safety of the method[4]. The chemotherapy as adjuvant treatment in breast cancer has been used in different settings. Chemotherapy neodjuvante (used before the surgical procedure) may benefit the patients, resulting in decreased tumor and axillary status and higher conversion rate of mastectomies in conservative surgery[5]

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