Decreased Identification Rate of Sentinel Lymph Node after Neoadjuvant Chemotherapy
- 29 September 2004
- journal article
- clinical trial
- Published by Wiley in World Journal of Surgery
- Vol. 28 (10), 1019-1024
- https://doi.org/10.1007/s00268-004-7367-7
Abstract
We prospectively studied the feasibility of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy by comparing the identification rate and the false-negative rate (FNR) with the results obtained from the patients without chemotherapy. From October 2001 to March 2003, a total of 284 consecutive patients who underwent SLNB and axillary lymph node dissection (ALND) at the Center for Breast Cancer, National Cancer Center were enrolled. Of the 284 patients, 54 underwent neoadjuvant chemotherapy prior to operation. The sentinel lymph node (SLN) was mapped by radioactive colloid alone or in combination with blue dye. All SLNs were evaluated by 2 mm serial sections after hematoxylin-eosin staining. The overall SLN identification rate was 91.9% (261/284): 72.2% (39/54) of the patients after chemotherapy and 96.5% (222/230) of the patients without chemotherapy. These results suggest that preoperative chemotherapy significantly affects lymphatic mapping (p< 0.001). Among the patients with chemotherapy, there were 3 false negatives in 39 successfully mapped tumors, yielding an FNR of 11.1% (3/27), a negative prediction value (NPV) of 80.0% (12/15), and an accuracy of 92.3% (36/39). There were 10 false negatives among 222 successfully detected patients without chemotherapy, yielding an FNR of 9.9% (10/101), an NPV of 92.4% (121/131), and an accuracy of 95.5% (212/222). These results were not statistically different when compared (p > 0.05). Although the SLN identification rate significantly decreased after neoadjuvant chemotherapy, SLNB could accurately predict axillary status. Thus SLNB can be an alternative to ALND even after neoadjuvant chemotherapy in cases of successful identification of the SLN.Funding Information
- National Cancer Center
This publication has 34 references indexed in Scilit:
- Sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapyJournal of Surgical Oncology, 2003
- Primary Chemotherapy Effect in Sentinel Node Detection in Breast CancerClinical Nuclear Medicine, 2003
- Determinants of Diagnostic Performance Of [F-18]Fluorodeoxyglucose Positron Emission Tomography for Axillary Staging in Breast CancerAnnals of Surgery, 2002
- Pathobiology of preoperative chemotherapyCancer, 2002
- Optimal use of sentinel lymph node biopsy versus axillary lymph node dissection in patients with breast carcinomaCancer, 2002
- Proceedings of the Consensus Conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, PennsylvaniaCancer, 2002
- Sentinel Lymphadenectomy After Neoadjuvant Chemotherapy for Breast Cancer May Reliably Represent the Axilla Except for Inflammatory Breast CancerAnnals of Surgical Oncology, 2002
- Analysis of Sentinel Lymph Node Mapping With Immediate Pathologic Review in Patients Receiving Preoperative Chemotherapy for Breast CarcinomaAnnals of Surgical Oncology, 2002
- Sentinel lymph node biopsy and breast cancerBritish Journal of Surgery, 2002
- Is sentinel lymph node biopsy reliable and indicated after preoperative chemotherapy in patients with breast carcinoma?Cancer, 2001