Andrea V Barrio1, Anita Mamtani2, Marcia Edelweiss3, Anne Eaton4, Michelle Stempel2, Melissa P Murray3, Monica Morrow2. 1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. barrioa@mskcc.org. 2. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
BACKGROUND: False-negative rates (FNR) of sentinel node biopsy (SNB) after neoadjuvant chemotherapy (NAC) in node-positive (N+) breast cancer patients are <10 % when ≥3 negative SNs are obtained. Marking positive nodes has been suggested to reduce FNR. Identification of treatment effect in the nodes post-NAC is an alternative to decrease FNR. We evaluated the frequency of treatment effect in N+ patients after a pathologic complete response (pCR) with NAC. METHODS: Biopsy-proven N+ patients receiving NAC were identified. Patients with nodal pCR after axillary lymph node dissection (ALND) or SNB with dual mapping and ≥3 SNs removed were evaluated for treatment effect; ALND and SNB patients were compared. RESULTS: From January 2009 to December 2015, 528 N+ patients received NAC. Of these, 204 had a nodal pCR, 135 had an ALND, and 69 had SNB. Median age was 49 years, 15 % were hormone receptor positive (HR+)/HER2-, 27 % triple negative, and 58 % HER2+. The median number of nodes removed in ALND patients was 17 versus 4 in SNB patients. Treatment effect in nodes was identified in 192 patients (94 %) and was more common in ALND versus SNB patients (97 vs 88 %; p = .02). HR+ patients and patients without a breast pCR were less likely to have treatment effect in the nodes (p = .05). Other characteristics did not differ. CONCLUSIONS: Following NAC, SNs with treatment effect were retrieved in 88 % of patients without marking nodes, suggesting that nodal clipping may not be necessary to achieve an acceptable FNR. Longer follow-up is needed to determine regional recurrence rates in the SN-only cohort.
BACKGROUND: False-negative rates (FNR) of sentinel node biopsy (SNB) after neoadjuvant chemotherapy (NAC) in node-positive (N+) breast cancerpatients are <10 % when ≥3 negative SNs are obtained. Marking positive nodes has been suggested to reduce FNR. Identification of treatment effect in the nodes post-NAC is an alternative to decrease FNR. We evaluated the frequency of treatment effect in N+ patients after a pathologic complete response (pCR) with NAC. METHODS: Biopsy-proven N+ patients receiving NAC were identified. Patients with nodal pCR after axillary lymph node dissection (ALND) or SNB with dual mapping and ≥3 SNs removed were evaluated for treatment effect; ALND and SNB patients were compared. RESULTS: From January 2009 to December 2015, 528 N+ patients received NAC. Of these, 204 had a nodal pCR, 135 had an ALND, and 69 had SNB. Median age was 49 years, 15 % were hormone receptor positive (HR+)/HER2-, 27 % triple negative, and 58 % HER2+. The median number of nodes removed in ALNDpatients was 17 versus 4 in SNB patients. Treatment effect in nodes was identified in 192 patients (94 %) and was more common in ALND versus SNBpatients (97 vs 88 %; p = .02). HR+patients and patients without a breast pCR were less likely to have treatment effect in the nodes (p = .05). Other characteristics did not differ. CONCLUSIONS: Following NAC, SNs with treatment effect were retrieved in 88 % of patients without marking nodes, suggesting that nodal clipping may not be necessary to achieve an acceptable FNR. Longer follow-up is needed to determine regional recurrence rates in the SN-only cohort.
Authors: Elizabeth A Mittendorf; Abigail S Caudle; Wei Yang; Savitri Krishnamurthy; Simona Shaitelman; Mariana Chavez-MacGregor; Wendy A Woodward; Isabelle Bedrosian; Henry M Kuerer; Kelly K Hunt Journal: Ann Surg Oncol Date: 2014-05-20 Impact factor: 5.344
Authors: Jean-Francois Boileau; Brigitte Poirier; Mark Basik; Claire M B Holloway; Louis Gaboury; Lucas Sideris; Sarkis Meterissian; Angel Arnaout; Muriel Brackstone; David R McCready; Stephen E Karp; Isabelle Trop; Andre Lisbona; Frances C Wright; Rami J Younan; Louise Provencher; Erica Patocskai; Atilla Omeroglu; Andre Robidoux Journal: J Clin Oncol Date: 2014-12-01 Impact factor: 44.544
Authors: Alexandra S Brown; Kelly K Hunt; Jeannie Shen; Lei Huo; Gildy V Babiera; Merrick I Ross; Funda Meric-Bernstam; Barry W Feig; Henry M Kuerer; Judy C Boughey; Christine D Ching; Michael Z Gilcrease Journal: Cancer Date: 2010-06-15 Impact factor: 6.860
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: 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: Judy C Boughey; Linda M McCall; Karla V Ballman; Elizabeth A Mittendorf; Gretchen M Ahrendt; Lee G Wilke; Bret Taback; A Marilyn Leitch; Teresa Flippo-Morton; Kelly K Hunt Journal: Ann Surg Date: 2014-10 Impact factor: 12.969
Authors: Abigail S Caudle; Wei T Yang; Savitri Krishnamurthy; Elizabeth A Mittendorf; Dalliah M Black; Michael Z Gilcrease; Isabelle Bedrosian; Brian P Hobbs; Sarah M DeSnyder; Rosa F Hwang; Beatriz E Adrada; Simona F Shaitelman; Mariana Chavez-MacGregor; Benjamin D Smith; Rosalind P Candelaria; Gildy V Babiera; Basak E Dogan; Lumarie Santiago; Kelly K Hunt; Henry M Kuerer Journal: J Clin Oncol Date: 2016-01-25 Impact factor: 44.544
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: Damian P McCartan; Emily C Zabor; Monica Morrow; Kimberly J Van Zee; Mahmoud B El-Tamer Journal: Ann Surg Oncol Date: 2017-07-12 Impact factor: 5.344
Authors: Anne Grabenstetter; Tracy-Ann Moo; Sabina Hajiyeva; Peter J Schüffler; Pallavi Khattar; Maria A Friedlander; Maura A McCormack; Monica Raiss; Emily C Zabor; Andrea Barrio; Monica Morrow; Marcia Edelweiss Journal: Am J Surg Pathol Date: 2019-10 Impact factor: 6.394
Authors: Yul Ri Chung; Ji Won Woo; Soomin Ahn; Eunyoung Kang; Eun-Kyu Kim; Mijung Jang; Sun Mi Kim; Se Hyun Kim; Jee Hyun Kim; So Yeon Park Journal: Sci Rep Date: 2021-06-09 Impact factor: 4.379