Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation
Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation
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DOI：
10.1245/s10434-007-9403-y
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发表时间：
2007-10-01
影响因子：
3.7
通讯作者：
Newman, Lisa A.
中科院分区：
文献类型：
--
作者：
Newman, Erika A.;Sabel, Michael S.;Newman, Lisa A.
背景资料：对于接受新辅助化疗的乳腺癌患者，将淋巴结定位和前哨淋巴结活检纳入管理的最佳策略仍存在争议。以前的研究前哨淋巴结活检后进行新辅助化疗的患者，化疗前，病理腋窝淋巴结的状态是未知的。我们报告的结果使用一种新的综合方法腋窝淋巴结阳性患者接受新辅助chemotherapy.Methods管理：我们评估了54个连续的乳腺癌患者活检证实腋窝淋巴结转移的诊断时，进行淋巴结活检，以及伴随腋窝淋巴结清扫后接受新辅助化疗。所有病例均于2001年至2005年在一家综合性癌症中心接受治疗。结果：新辅助化疗后前哨淋巴结识别率为98%。36例患者（66%）有残留腋窝转移（包括8例在诊断时接受转移性前哨淋巴结切除术的患者），12例（31%）残留转移性疾病仅限于前哨淋巴结。最终，新辅助化疗后前哨淋巴结在3例（8.6%）中为假阴性。阴性的最终前哨淋巴结准确地识别了17例（32%）无腋窝残留疾病的患者。在新辅助化疗后，对就诊时有淋巴结疾病记录的患者进行前哨淋巴结活检，可以准确识别可能已降级为淋巴结阴性状态的病例，并且可以避免这部分患者（32%）免受腋窝淋巴结清扫的折磨
Background: The optimal strategy for incorporating lymphatic mapping and sentinel lymph node biopsy into the management of breast cancer patients receiving neoadjuvant chemotherapy remains controversial. Previous studies of sentinel node biopsy performed following neoadjuvant chemotherapy have largely reported on patients whose prechemotherapy, pathologic axillary nodal status was unknown. We report findings using a novel comprehensive approach to axillary management of node-positive-patients receiving neoadjuvant chemotherapy.Methods: We evaluated 54 consecutive breast cancer patients with biopsy-proven axillary nodal metastases at the time of diagnosis that underwent lymphatic mapping with nodal biopsy as well as concomitant axillary lymph node dissection after receiving neoadjuvant chemotherapy. All cases were treated at a single comprehensive cancer center between 2001 and 2005.Results: The sentinel node identification rate after delivery of neoadjuvant chemotherapy was 98%. Thirty-six patients (66%) had residual axillary metastases (including eight patients that had undergone resection of metastatic sentinel nodes at the time of diagnosis), and in 12 cases (31%) the residual metastatic disease was limited to the sentinel lymph node. The final, post-neoadjuvant chemotherapy sentinel node was falsely negative in three cases (8.6%). The negative final sentinel node accurately identified patients with no residual axillary disease in 17 cases (32%).Conclusions: Sentinel lymph node biopsy performed after the delivery of neoadjuvant chemotherapy in patients with documented nodal disease at presentation accurately identified cases that may have been downstaged to node-negative status and can spare this subset of patients (32%) from experiencing the morbidity of an axillary dissection.