Alejandra García-Novoa1, Benigno Acea-Nebril2, Carlota Díaz Carballada3, Alberto Bouzón Alejandro2, Carmen Conde3, Carmen Cereijo Garea4, José Ramón Varela5, Paz Santiago Freijanes6, Silvia Antolín Novoa7, Lourdes Calvo Martínez7, Inma Díaz8, Sofia Rodríguez Martínez9, Joaquin Mosquera Oses5. 1. Breast Unit, Department of General Surgery, University Hospital Complex of A Coruña, A Coruña, Spain. malejandragarcianovoa@gmail.com. 2. Breast Unit, Department of General Surgery, University Hospital Complex of A Coruña, A Coruña, Spain. 3. Breast Unit, Department of Gynecology, University Hospital Complex of A Coruña, A Coruña, Spain. 4. Breast Unit, Case Manager Nurse, University Hospital Complex of A Coruña, A Coruña, Spain. 5. Breast Unit, Department of Radiology, University Hospital Complex of A Coruña, A Coruña, Spain. 6. Breast Unit, Department of Pathology, University Hospital Complex of A Coruña, A Coruña, Spain. 7. Breast Unit, Department of Oncology, University Hospital Complex of A Coruña, A Coruña, Spain. 8. Breast Unit, Department of Radiation Therapy, University Hospital Complex of A Coruña, A Coruña, Spain. 9. Breast Unit, Department of Nuclear Medicine, University Hospital Complex of A Coruña, A Coruña, Spain.
Abstract
BACKGROUND: The ideal technique for lymph node staging for patients with pathologically confirmed node-positive breast cancer at diagnosis and neoadjuvant chemotherapy (NAC) is unclear. OBJECTIVE: The aim of this study was to analyze the feasibility of wire/clip localization and sentinel lymph node biopsy (SLNB) for the axillary staging of these patients. METHODS: We conducted a prospective study in which lymph node staging was performed using wire localization of positive lymph nodes and an SLNB with dual tracer. All patients who presented no metastatic involvement of the sentinel lymph node (SLN) or clip/wire-marked lymph node were spared an axillary lymph node dissection (ALND). The multidisciplinary committee agreed on axillary treatment for patients with lymph node involvement. RESULTS: Forty-two patients met the inclusion criteria. We identified and extirpated the clip/wire-marked node in all patients (100%), with SLNB performed successfully in 95.3% of patients. The SLN and wire-marked node matched in 80% of patients; 73.8% of patients did not undergo ALND. DISCUSSION AND CONCLUSIONS: Several studies have evaluated the efficacy of various procedures for lymph node marking for women with prechemotherapy lymph node involvement. Most of the studies reported high identification rates (> 94.8%), with false negative rates of < 7%. Similarly, our study allows us to conclude that combined axillary marking (clip and SLNB) in patients with metastatic lymph node at diagnosis and NAC offers a high identification rate (100%) and a high correlation between the wire-marked lymph node and the SLN (80%). This procedure has enabled the suppression of ALND for a significant number of patients (73%).
BACKGROUND: The ideal technique for lymph node staging for patients with pathologically confirmed node-positive breast cancer at diagnosis and neoadjuvant chemotherapy (NAC) is unclear. OBJECTIVE: The aim of this study was to analyze the feasibility of wire/clip localization and sentinel lymph node biopsy (SLNB) for the axillary staging of these patients. METHODS: We conducted a prospective study in which lymph node staging was performed using wire localization of positive lymph nodes and an SLNB with dual tracer. All patients who presented no metastatic involvement of the sentinel lymph node (SLN) or clip/wire-marked lymph node were spared an axillary lymph node dissection (ALND). The multidisciplinary committee agreed on axillary treatment for patients with lymph node involvement. RESULTS: Forty-two patients met the inclusion criteria. We identified and extirpated the clip/wire-marked node in all patients (100%), with SLNB performed successfully in 95.3% of patients. The SLN and wire-marked node matched in 80% of patients; 73.8% of patients did not undergo ALND. DISCUSSION AND CONCLUSIONS: Several studies have evaluated the efficacy of various procedures for lymph node marking for women with prechemotherapy lymph node involvement. Most of the studies reported high identification rates (> 94.8%), with false negative rates of < 7%. Similarly, our study allows us to conclude that combined axillary marking (clip and SLNB) in patients with metastatic lymph node at diagnosis and NAC offers a high identification rate (100%) and a high correlation between the wire-marked lymph node and the SLN (80%). This procedure has enabled the suppression of ALND for a significant number of patients (73%).
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