Implementation of the American College of Surgeons Oncology Group Z1071 Trial Data in Clinical Practice: Is There a Way Forward for Sentinel Lymph Node Dissection in Clinically Node-Positive Breast Cancer Patients Treated with Neoadjuvant Chemotherapy?
Open Access
- 20 May 2014
- journal article
- Published by Springer Science and Business Media LLC in Annals of Surgical Oncology
- Vol. 21 (8), 2468-2473
- https://doi.org/10.1245/s10434-014-3775-6
Abstract
For clinically node-positive breast cancer patients receiving neoadjuvant chemotherapy, approximately 40 % will be found to be pathologically node negative. The American College of Surgeons Oncology Group Z1071 trial was therefore conducted to evaluate sentinel lymph node dissection (SLND) in these patients. The trial’s primary end point was to determine the false-negative rate (FNR) among patients with clinical N1 disease in whom at least 2 sentinel lymph nodes (SLNs) were identified. The FNR was 12.6 %, which exceeded the prespecified end point of 10.0 %. After data publication, our multidisciplinary team discussed the trial results and how we may incorporate the findings into clinical practice. Patient selection and surgical technique are critical. As an example, when dual tracer technique was used, the FNR was 10.8 %. Data from the trial presented at the San Antonio Breast Cancer Symposium suggested that the FNR could be improved if a clip was placed in the biopsy-proven positive lymph node and removal of that node during SLND was confirmed. Taking this into consideration, we have proposed an approach to surgical management of the axilla in clinically node-positive patients receiving neoadjuvant chemotherapy termed targeted axillary dissection (TAD). TAD involves placing a clip at the time a lymph node is determined to be positive. After completion of neoadjuvant chemotherapy, the clipped node is localized by using a wire or radioactive seed, and during the SLND procedure, all SLNs and the clipped node are removed. We are currently evaluating the efficacy of TAD in axillary staging after neoadjuvant chemotherapy.Keywords
This publication has 22 references indexed in Scilit:
- Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy in Patients With Node-Positive Breast CancerJAMA, 2013
- Predictors of Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From Combined Analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27Journal of Clinical Oncology, 2012
- Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trialThe Lancet Oncology, 2012
- Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients: A systematic reviewEuropean Journal Of Cancer, 2009
- Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy for Advanced Breast Cancer: Results of Ganglion Sentinelle et Chimiothérapie Neoadjuvante, a French Prospective Multicentric StudyJournal of Clinical Oncology, 2009
- Sentinel Lymph Node Biopsy Performed After Neoadjuvant Chemotherapy is Accurate in Patients with Documented Node-Positive Breast Cancer at PresentationAnnals of Surgical Oncology, 2007
- Feasibility and Accuracy of Sentinel Lymph Node Biopsy After Preoperative Chemotherapy in Breast Cancer Patients With Documented Axillary MetastasesCancer, 2007
- Lymphatic mapping and sentinel lymph node biopsy in early‐stage breast carcinomaCancer, 2005
- Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancerBritish Journal of Surgery, 2005
- Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancerBreast Cancer Research and Treatment, 2005