Axillary and internal mammary sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy
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Xiao-Shan Cao1, Hui-Juan Li2, Bin-Bin Cong1,3, Xiao Sun1, Peng-Fei Qiu1, Yan-Bing Liu1, Chun-Jian Wang1, Yong-Sheng Wang1
1Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
2Department of Medical Administration Division, Shandong Cancer Hospital affiliated to Shandong University, Jinan, Shandong, China
3School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan, Shandong, China
Yong-Sheng Wang, email: [email protected]
Keywords: breast cancer, neoadjuvant chemotherapy, sentinel lymph node biopsy, internal mammary, axilla
Received: June 29, 2016 Accepted: September 26, 2016 Published: October 12, 2016
With the improvement of neoadjuvant chemotherapy (NAC), the proportion of pathological complete response (pCR) in the breast and axillary lymph node (ALN) is increasing. The evaluation of pCR does not include the status of internal mammary lymph node (IMLN). This study is to evaluate the roles of both axillary sentinel lymph node biopsy (ASLNB) and internal mammary sentinel lymph node biopsy (IM-SLNB) in breast cancer patients after NAC. There were 74 patients enrolled into this study. IM-SLNB was performed on patients with radioactive internal mammary sentinel lymph node (IM-SLN). Patients (n = 8) with cN0 and ycN0 received ASLNB, and axillary lymph node dissection (ALND) in cases of positive axillary sentinel lymph node (ASLN). Patients (n = 48) with cN+ but ycN0 received ASLNB and ALND. Patients (n = 18) with ycN+ received ALND without ASLNB. The visualization rate of IM-SLN was 56.8% (42/74). The success rate of IM-SLNB was 97.6% (41/42) and the metastasis rate of IM-SLN was 7.3% (3/41). The success rate of ASLNB was 100% (56/56). The false negative rate (FNR) of ASLNB was 17.2% (5/29). The FNR in patients with 1, 2 and ≥ 3ASLNs examined was 27.3% (3/11), 20.0% (2/10) and 0% (0/8) respectively. ASLNB could be performed on ycN0 after NAC, and ALND should be performed on initially ALN-positive patients. IM-SLNB should be considered after NAC, especially for patients with clinically positive axillary nodes before NAC, which might help make clear of the pathological nodal staging of both ALN and IMLN, improve the definition of nodal pCR, and guide the individual adjuvant regional and systemic therapy.
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