The feasibility of sentinel lymph node biopsy in breast cancer patients after primary systemic therapy

Abstract

Aims: Sentinel lymph node biopsy (SLNB) without axillary lymph node dissection (ALND) in SLN negative patients is a standard of care for most breast cancer patients. SLNB for axillary staging after primary systemic therapy (PST) is still contraindicated due to possibly reduced accuracy, while data are lacking. Purpose of this study was to evaluate the accuracy of SLNB after PST. Material and methods: 185 breast cancer patients were treated with PST, 160 patients received preoperative chemotherapy and 25 patients received preoperative endocrine therapy. 143/160 patients with preoperative chemotherapy and 22/25 patients with preoperative endocrine therapy were eligible for evaluation. The combination of blue dye and radioactive tracer was used for identification of SLNs. All patients received SLNB and axillary lymph node dissection (ALND). Results: Pathologic complete response rates and breast conserving therapy rates were 15% and 71.9% in the preoperative chemotherapy group and 0% and 72% in the preoperative endocrine therapy group, respectively. Identification rate, sensitivity, overall accuracy and false negative rate were 81.1% (116/143), 91.7% (55/60), 95.7% (111/116) and 8.3% (5/60) in the preoperative chemotherapy group and 77.3% (17/22), 90.0% (9/10), 94.1% (16/17) and 10.0% (1/10) in the preoperative endocrine therapy group, respectively. Conclusion: SLNB after primary systemic therapy is accurate and the results are comparable to those of primary SLNB. SLNB after PST could spare ALND in up to 40% of patients with primary positive axillary lymph nodes.