Tracy-Ann Moo1, Marcia Edelweiss2, Sabina Hajiyeva2, Michelle Stempel1, Monica Raiss1, Emily C Zabor3, Andrea Barrio1, Monica Morrow4. 1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 2. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. morrowm@mskcc.org.
Abstract
BACKGROUND/ OBJECTIVE: Intraoperative evaluation of sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) has a higher false-negative rate than in the primary surgical setting, particularly for small tumor deposits. Additional tumor burden seen with isolated tumor cells (ITCs) and micrometastases following primary surgery is low; however, it is unknown whether the same is true after NAC. We examined the false-negative rate of intraoperative frozen section (FS) after NAC, and the association between SLN metastasis size and residual disease at axillary lymph node dissection (ALND). METHODS: Patients undergoing SLN biopsy after NAC were identified. The association between SLN metastasis size and residual axillary disease was examined. RESULTS: From July 2008 to July 2017, 702 patients (711 cancers) had SLN biopsy after NAC. On FS, 181 had metastases, 530 were negative; 33 negative cases were positive on final pathology (false-negative rate 6.2%). Among patients with a positive FS, 3 (2%) had ITCs and no further disease on ALND; 41 (23%) had micrometastases and 125 (69%) had macrometastases. Fifty-nine percent of patients with micrometastases and 63% with macrometastases had one or more additional positive nodes at ALND. Among those with a false-negative result, 10 (30%) had ITCs, 15 (46%) had micrometastases, and 8 (24%) had macrometastases; 17 had ALND and 59% had one or more additional positive lymph nodes. Overall, 1/6 (17%) patients with ITCs and 28/44 (64%) patients with micrometastases had additional nodal metastases at ALND. CONCLUSION: Low-volume SLN disease after NAC is not an indicator of a low risk of additional positive axillary nodes and remains an indication for ALND, even when not detected on intraoperative FS.
BACKGROUND/ OBJECTIVE: Intraoperative evaluation of sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) has a higher false-negative rate than in the primary surgical setting, particularly for small tumor deposits. Additional tumor burden seen with isolated tumor cells (ITCs) and micrometastases following primary surgery is low; however, it is unknown whether the same is true after NAC. We examined the false-negative rate of intraoperative frozen section (FS) after NAC, and the association between SLN metastasis size and residual disease at axillary lymph node dissection (ALND). METHODS:Patients undergoing SLN biopsy after NAC were identified. The association between SLN metastasis size and residual axillary disease was examined. RESULTS: From July 2008 to July 2017, 702 patients (711 cancers) had SLN biopsy after NAC. On FS, 181 had metastases, 530 were negative; 33 negative cases were positive on final pathology (false-negative rate 6.2%). Among patients with a positive FS, 3 (2%) had ITCs and no further disease on ALND; 41 (23%) had micrometastases and 125 (69%) had macrometastases. Fifty-nine percent of patients with micrometastases and 63% with macrometastases had one or more additional positive nodes at ALND. Among those with a false-negative result, 10 (30%) had ITCs, 15 (46%) had micrometastases, and 8 (24%) had macrometastases; 17 had ALND and 59% had one or more additional positive lymph nodes. Overall, 1/6 (17%) patients with ITCs and 28/44 (64%) patients with micrometastases had additional nodal metastases at ALND. CONCLUSION:Low-volume SLN disease after NAC is not an indicator of a low risk of additional positive axillary nodes and remains an indication for ALND, even when not detected on intraoperative FS.
Authors: Catherine L Akay; Constance Albarracin; Tiffany Torstenson; Roland Bassett; Elizabeth A Mittendorf; Min Yi; Henry M Kuerer; Gildy V Babiera; Isabelle Bedrosian; Kelly K Hunt; Rosa F Hwang Journal: Breast J Date: 2017-06-13 Impact factor: 2.431
Authors: P Gimbergues; M M Dauplat; X Durando; C Abrial; G Le Bouedec; M A Mouret-Reynier; F Cachin; F Kwiatkowski; Andrei Tchirkov; J Dauplat; F Penault-Llorca Journal: Ann Surg Oncol Date: 2010-02-13 Impact factor: 5.344
Authors: Armando E Giuliano; Kelly K Hunt; Karla V Ballman; Peter D Beitsch; Pat W Whitworth; Peter W Blumencranz; A Marilyn Leitch; Sukamal Saha; Linda M McCall; Monica Morrow Journal: JAMA Date: 2011-02-09 Impact factor: 56.272
Authors: V Galimberti; S K Ribeiro Fontana; P Maisonneuve; F Steccanella; A R Vento; M Intra; P Naninato; P Caldarella; M Iorfida; M Colleoni; G Viale; C M Grana; N Rotmensz; A Luini Journal: Eur J Surg Oncol Date: 2015-12-25 Impact factor: 4.424
Authors: Armando E Giuliano; Karla V Ballman; Linda McCall; Peter D Beitsch; Meghan B Brennan; Pond R Kelemen; David W Ollila; Nora M Hansen; Pat W Whitworth; Peter W Blumencranz; A Marilyn Leitch; Sukamal Saha; Kelly K Hunt; Monica Morrow Journal: JAMA Date: 2017-09-12 Impact factor: 56.272
Authors: Linda Holmstrand Zetterlund; Jan Frisell; Athanasios Zouzos; Rimma Axelsson; Thomas Hatschek; Jana de Boniface; Fuat Celebioglu Journal: Breast Cancer Res Treat Date: 2017-02-21 Impact factor: 4.872
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: Anna Weiss; Claire King; Julie Vincuilla; Tonia Parker; Leah Portnow; Faina Nakhlis; Laura Dominici; Elizabeth A Mittendorf; Tari A King Journal: Breast Cancer Res Treat Date: 2022-07-28 Impact factor: 4.624
Authors: Julia Foldi; Mariya Rozenblit; Tristen S Park; Christin A Knowlton; Mehra Golshan; Meena Moran; Lajos Pusztai Journal: Curr Treat Options Oncol Date: 2021-07-02