PURPOSE: Placing clips in nodes with biopsy-confirmed metastasis before initiating neoadjuvant therapy allows for evaluation of response in breast cancer. Our goal was to determine if pathologic changes in clipped nodes reflect the status of the nodal basin and if targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of clipped nodes, improves the false-negative rate (FNR) compared with SLND alone. METHODS: A prospective study of patients with biopsy-confirmed nodal metastases with a clip placed in the sampled node was performed. After neoadjuvant therapy, patients underwent axillary surgery and the pathology of the clipped node was compared with other nodes. Patients undergoing TAD had SLND and selective removal of the clipped node using iodine-125 seed localization. The FNR was determined in patients undergoing complete axillary lymphadenectomy (ALND). RESULTS: Of 208 patients enrolled in this study, 191 underwent ALND, with residual disease identified in 120 (63%). The clipped node revealed metastases in 115 patients, resulting in an FNR of 4.2% (95% CI, 1.4 to 9.5) for the clipped node. In patients undergoing SLND and ALND (n = 118), the FNR was 10.1% (95% CI, 4.2 to 19.8), which included seven false-negative events in 69 patients with residual disease. Adding evaluation of the clipped node reduced the FNR to 1.4% (95% CI, 0.03 to 7.3; P = .03). The clipped node was not retrieved as an SLN in 23% (31 of 134) of patients, including six with negative SLNs but metastasis in the clipped node. TAD followed by ALND was performed in 85 patients, with an FNR of 2.0% (1 of 50; 95% CI, 0.05 to 10.7). CONCLUSION: Marking nodes with biopsy-confirmed metastatic disease allows for selective removal and improves pathologic evaluation for residual nodal disease after chemotherapy.
PURPOSE: Placing clips in nodes with biopsy-confirmed metastasis before initiating neoadjuvant therapy allows for evaluation of response in breast cancer. Our goal was to determine if pathologic changes in clipped nodes reflect the status of the nodal basin and if targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of clipped nodes, improves the false-negative rate (FNR) compared with SLND alone. METHODS: A prospective study of patients with biopsy-confirmed nodal metastases with a clip placed in the sampled node was performed. After neoadjuvant therapy, patients underwent axillary surgery and the pathology of the clipped node was compared with other nodes. Patients undergoing TAD had SLND and selective removal of the clipped node using iodine-125 seed localization. The FNR was determined in patients undergoing complete axillary lymphadenectomy (ALND). RESULTS: Of 208 patients enrolled in this study, 191 underwent ALND, with residual disease identified in 120 (63%). The clipped node revealed metastases in 115 patients, resulting in an FNR of 4.2% (95% CI, 1.4 to 9.5) for the clipped node. In patients undergoing SLND and ALND (n = 118), the FNR was 10.1% (95% CI, 4.2 to 19.8), which included seven false-negative events in 69 patients with residual disease. Adding evaluation of the clipped node reduced the FNR to 1.4% (95% CI, 0.03 to 7.3; P = .03). The clipped node was not retrieved as an SLN in 23% (31 of 134) of patients, including six with negative SLNs but metastasis in the clipped node. TAD followed by ALND was performed in 85 patients, with an FNR of 2.0% (1 of 50; 95% CI, 0.05 to 10.7). CONCLUSION: Marking nodes with biopsy-confirmed metastatic disease allows for selective removal and improves pathologic evaluation for residual nodal disease after chemotherapy.
Authors: Rosalinda Alvarado; Min Yi; Huong Le-Petross; Michael Gilcrease; Elizabeth A Mittendorf; Isabelle Bedrosian; Rosa F Hwang; Abigail S Caudle; Gildy V Babiera; Jeri S Akins; Henry M Kuerer; Kelly K Hunt Journal: Ann Surg Oncol Date: 2012-07-07 Impact factor: 5.344
Authors: H M Kuerer; A A Sahin; K K Hunt; L A Newman; T M Breslin; F C Ames; M I Ross; A U Buzdar; G N Hortobagyi; S E Singletary Journal: Ann Surg Date: 1999-07 Impact factor: 12.969
Authors: Anthony Lucci; Linda Mackie McCall; Peter D Beitsch; Patrick W Whitworth; Douglas S Reintgen; Peter W Blumencranz; A Marilyn Leitch; Sukumal Saha; Kelly K Hunt; Armando E Giuliano Journal: J Clin Oncol Date: 2007-05-07 Impact factor: 44.544
Authors: Mila Donker; Marieke E Straver; Jelle Wesseling; Claudette E Loo; Margaret Schot; Caroline A Drukker; Harm van Tinteren; Gabe S Sonke; Emiel J Th Rutgers; Marie-Jeanne T F D Vrancken Peeters Journal: Ann Surg Date: 2015-02 Impact factor: 12.969
Authors: Judy C Boughey; Vera J Suman; Elizabeth A Mittendorf; Gretchen M Ahrendt; Lee G Wilke; Bret Taback; A Marilyn Leitch; Henry M Kuerer; Monet Bowling; Teresa S Flippo-Morton; David R Byrd; David W Ollila; Thomas B Julian; Sarah A McLaughlin; Linda McCall; W Fraser Symmans; Huong T Le-Petross; Bruce G Haffty; Thomas A Buchholz; Heidi Nelson; Kelly K Hunt Journal: JAMA Date: 2013-10-09 Impact factor: 56.272
Authors: Erika A Newman; Michael S Sabel; Alexis V Nees; Anne Schott; Kathleen M Diehl; Vincent M Cimmino; Alfred E Chang; Celina Kleer; Daniel F Hayes; Lisa A Newman Journal: Ann Surg Oncol Date: 2007-05-19 Impact factor: 5.344
Authors: Judy C Boughey; Karla V Ballman; Huong T Le-Petross; Linda M McCall; Elizabeth A Mittendorf; Gretchen M Ahrendt; Lee G Wilke; Bret Taback; Eric C Feliberti; Kelly K Hunt Journal: Ann Surg Date: 2016-04 Impact factor: 12.969
Authors: Muayad F Almahariq; Ronald Levitin; Thomas J Quinn; Peter Y Chen; Nayana Dekhne; Sayee Kiran; Amita Desai; Pamela Benitez; Maha S Jawad; Gregory S Gustafson; Joshua T Dilworth Journal: Ann Surg Oncol Date: 2020-07-25 Impact factor: 5.344
Authors: Wolfram Malter; Christian Eichler; Bettina Hanstein; Peter Mallmann; Johannes Holtschmidt Journal: In Vivo Date: 2020 May-Jun Impact factor: 2.155
Authors: Jennifer L Baker; Shirin Muhsen; Emily C Zabor; Michelle Stempel; Mary L Gemignani Journal: Ann Surg Oncol Date: 2018-11-30 Impact factor: 5.344
Authors: S David Nathanson; David Krag; Henry M Kuerer; Lisa A Newman; Markus Brown; Dontscho Kerjaschki; Ethel R Pereira; Timothy P Padera Journal: Clin Exp Metastasis Date: 2018-05-23 Impact factor: 5.150
Authors: Anita Mamtani; Andrea V Barrio; Tari A King; Kimberly J Van Zee; George Plitas; Melissa Pilewskie; Mahmoud El-Tamer; Mary L Gemignani; Alexandra S Heerdt; Lisa M Sclafani; Virgilio Sacchini; Hiram S Cody; Sujata Patil; Monica Morrow Journal: Ann Surg Oncol Date: 2016-05-09 Impact factor: 5.344
Authors: Abigail S Caudle; Henry M Kuerer; Savitri Krishnamurthy; Kyungmin Shin; Brian P Hobbs; Junsheng Ma; Elizabeth A Mittendorf; Ashley C Washington; Sarah M DeSnyder; Dalliah M Black; Kelly K Hunt; Wei T Yang Journal: Cancer Date: 2018-10-25 Impact factor: 6.860