Abstract
Purpose: There are still un-responded questions concerning the type of and the timing of axillary procedures that has to be performed in association with neoadjuvant chemotherapy. Methods: We led a prospective, multicentric, non-randomized study to evaluate the feasibility and accuracy of sentinel lymph node biopsy before neoadjuvant chemotherapy. The clinical and radiological response to chemotherapy was evaluated after 4 treatment cycles and at the end of chemotherapy. Axillary lymph node dissection was performed 3 to 4 weeks after chemotherapy. Histological analysis of sentinel lymph node biopsies and axillary lymph node dissections were studied for each patient. Results: Eighty nine patients had sentinel lymph node biopsy. The identification rate for sentinel lymph nodes was 98.9%. The sentinel lymph node biopsies were metastatic in 44 of 88 patients. Axillary lymph nodes were metastatic in 12 cases. The negative predictive value was 91.1% [95%CI: 85.1% - 97.1%]. Conclusion: Identification rate and negative predictive value of sentinel lymph node biopsy prior to neoadjuvant chemotherapy confirm that the procedure is suitable with its use in standard practice. This approach comprises two surgical procedures, but allows a better nodal status evaluation.
Highlights
The recourse to neoadjuvant chemotherapy (NC) has increased during the last years as it sometimes allows breast conservation and permits an evaluation of tumor response though providing prognostic information
Identification rate and negative predictive value of sentinel lymph node biopsy prior to neoadjuvant chemotherapy confirm that the procedure is suitable with its use in standard practice
Jones et al and the meta-analysis of Iwase et al found a significantly better identification rates when Sentinel Lymph Node Biopsy (SLNB) was performed before neoadjuvant chemotherapy (96% 100% versus 71% - 98%), and though recommended the procedure before NC for clinically N0 patients [5,6]
Summary
The recourse to neoadjuvant chemotherapy (NC) has increased during the last years as it sometimes allows breast conservation and permits an evaluation of tumor response though providing prognostic information. A meta-analysis has shown that identification rates for SLNB after neoadjuvant chemotherapy, are suitable with its use in standard practice [4]. Jones et al and the meta-analysis of Iwase et al found a significantly better identification rates when SLNB was performed before neoadjuvant chemotherapy (96% 100% versus 71% - 98%), and though recommended the procedure before NC for clinically N0 patients [5,6]. Last, it may give data useful in guiding systemic [7], radiation
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