Sentinel Lymph Node Biopsy Prior to Neoadjuvant Chemotherapy: A Series of 89 Patients

Flipo Bernard, Clough Krishna, Nos Claude, Miramand Bernard, Michel Cecile, Houvenaeghel Gilles, Meurette Jacques, Alfonsi Jean-Pierre

Alfonsi Jean-Pierre, Clinique St Antoine, Ville di Pietrabugno, France.
Breast Surgery Department, Centre Antoine Lacassagne, Nice, France.
Clough Krishna, Institut du Sein, Paris, France.
Houvenaeghel Gilles, Institut Paoli-Calmettes, Marseille, France.
Meurette Jacques, Clinique Ste-Amé, Lambres lez Douai, France.
Michel Cecile, Biostatistics Department, Centre Antoine Lacassagne, Nice, France.
Miramand Bernard, Polyclinique Urbain V, Avignon, France.
Nos Claude, Institut du Sein, Paris, France.

DOI: 10.4236/jct.2012.36129                

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.

Keywords

Breast Cancer; Neoadjuvant Therapy; Clinical Trial; Sentinel Lymph Node Biopsy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. M. Ververs, R. M. Roumen, A. J. Vingerhoets, et al., “Risk, Severity and Predictors of Physical and Psychological Morbidity after Axillary Lymph Node Dissection for Breast Cancer,” European Journal of Cancer, Vol. 37, No. 8, 2001, pp. 991-999. doi:10.1016/S0959-8049(01)00067-3
[2]	U. Veronesi, G. Paganelli, G. Viale, et al., “A Randomized Comparison of Sentinel-Node Biopsy with Routine Axillary Dissection in Breast Cancer,” New England Journal of Medicine, Vol. 349, No. 6, 2003, pp. 546-553. doi:10.1056/NEJMoa012782
[3]	J. P. Menard, J. M. Extra, J. Jacquemier, et al., “Sentinel Lymphadenectomy for the Staging of Clinical Axillary Node-Negative Breast Cancer before Neoadjuvant Chemotherapy,” European Journal of Surgical Oncology, Vol. 35, No. 9, 2009, pp. 916-920. doi:10.1016/j.ejso.2008.11.002
[4]	Y. Xing, M. Foy, C. D.D, et al., “Meta-Analysis of Sentinel Lymph Node Biopsy after Preoperative Chemotherapy in Patients with Breast Cancer,” British Journal of Surgery, Vol. 93, No. 5, 2006, pp. 539-546. doi:10.1002/bjs.5209
[5]	H. Iwase, Y. Yamamoto, T. Kawasoe, et al., “Advantage of Sentinel Lymph Node Biopsy before Neoadjuvant Chemotherapy in Breast Cancer Treatment,” Surgery Today, Vol. 39, No. 5, 2009, pp. 374-380. doi:10.1007/s00595-008-3880-x
[6]	J. L. Jones, K. Zabicki, R. L. Christian, et al., “A Comparison of Sentinel Node Biopsy before and after Neoadjuvant Chemotherapy: Timing Is Important,” The American Journal of Surgery, Vol. 190, 2005, pp. 517-520. doi:10.1016/j.amjsurg.2005.06.004
[7]	G. Bonadonna, P. Valagussa, A. Moliterni, et al., “Adjuvant Cyclophosphamide, Methotrexate, and Fluorouracil in Node-Positive Breast Cancer: The Results of 20 Years of Follow-Up,” New England Journal of Medicine, Vol. 332, No. 14, 1995, pp. 901-906. doi:10.1056/NEJM199504063321401
[8]	S. E. Singletary, C. Allred, P. Ashley, et al., “Staging System for Breast Cancer: Revisions for the 6th Edition of the AJCC Cancer Staging Manual,” Surgical Clinics of North America, Vol. 83, No. 4, 2003, pp. 803-819.
[9]	L. Lelievre, G. Houvenaeghel, M. Buttarelli, et al., “Value of the Sentinel Lymph Node Procedure in Patients with Large Size Breast Cancer,” Annals of Surgical Oncology, Vol. 14, No. 2, 2007, pp. 621-626. doi:10.1245/s10434-006-9232-4
[10]	D. M. Sataloff, B. A. Mason, A. J. Prestipino, et al., “Pathologic Response to Induction Chemotherapy in Locally Advanced Carcinoma of the Breast: A Determinant of Outcome,” Journal of the American College of Surgeons, Vol. 180, No. 3, 1995, pp. 297-306.
[11]	F. J. Fleming, D. Kavanagh, T. B. Crotty, et al., “Factors Affecting Metastases to Non-Sentinel Lymph Nodes in Breast Cancer,” Journal of Clinical Pathology, Vol. 57, No. 1, 2004, pp. 73-76. doi:10.1136/jcp.57.1.73
[12]	H. M. Kuerer, A. A. Sahin, K. K. Hunt, et al., “Incidence and Impact of Documented Eradication of Breast Cancer Axillary Lymph Node Metastases Before Surgery in Patients Treated with Neoadjuvant Chemotherapy,” Annals of Surgery, Vol. 230, No. 1, 1999, pp. 72-78. doi:10.1097/00000658-199907000-00011
[13]	K. Shimazu and S. Noguchi, “Sentinel Lymph Node Biopsy before versus after Neoadjuvant Chemotherapy for Breast Cancer,” Surgery Today, Vol. 41, No. 3, 2011, pp. 311-316. doi:10.1007/s00595-010-4404-z
[14]	B. T. Hennessy, G. N. Hortobagyi, R. Rouzier, et al., “Outcome after Pathologic Complete Eradication of Cytologically Proven Breast Cancer Axillary Node Metastases Following Primary Chemotherapy,” Journal of Clinical Oncology, Vol. 23, No. 36, 2005, pp. 9304-9311. doi:10.1200/JCO.2005.02.5023
[15]	D. N. Krag, S. J. Anderson, T. B. Julian, et al., “Sentinel-Lymph-Node Resection Compared with Conventional Axillary-Lymph-Node Dissection in Clinically Node-Negative Patients with Breast Cancer: Overall Survival Findings from the NSABP B-32 Randomised Phase 3 Trial,” The Lancet Oncology, Vol. 11, 2010, pp. 927-933. doi:10.1016/S1470-2045(10)70207-2
[16]	E. R. Port, J. Fey, M. L. Gemignani, et al., “Reoperative Sentinel Lymph Node Biopsy: A New Option for Patients with Primary or Locally Recurrent Breast Carcinoma,” Journal of the American College of Surgeons, Vol. 195, No. 2, 2002, pp. 167-172. doi:10.1016/S1072-7515(02)01268-1
[17]	A. E. Giuliano, K. K. Hunt, K. V. Ballman, et al., “Axillary Dissection vs No Axillary Dissection in Women with Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial,” JAMA, Vol. 305, No. 6, 2011, pp. 569-575. doi:10.1001/jama.2011.90
[18]	B. P. Baruah, A. Goyal, P. Young, et al., “Axillary Node Staging by Ultrasonography and Fine-Needle Aspiration Cytology in Patients with Breast Cancer,” British Journal of Surgery, Vol. 97, No. 5, 2010, pp. 680-683. doi:10.1002/bjs.6964