Andrea P Damin1,2, Maira Zancan3, Marcia P Melo4, Jorge V Biazus3,4. 1. Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. adamin@hcpa.edu.br. 2. Division of Breast Surgery, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350 - room 600, Porto Alegre, RS, Zip Code 90035-903, Brazil. adamin@hcpa.edu.br. 3. Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. 4. Division of Breast Surgery, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350 - room 600, Porto Alegre, RS, Zip Code 90035-903, Brazil.
Abstract
PURPOSE: The role of sentinel lymph node biopsy (SLNB) in breast cancer patients who undergo neoadjuvant chemotherapy (NAC) remains controversial. This study aims to investigate if axillary lymph node dissection (ALND) could be safely omitted after a negative SLNB in cN1/2 patients who become cN0 after NAC. METHODS: We retrospectively assessed T1-4, cN1/2 patients who were submitted to NAC between 2010 and 2016. T1-T3 patients who achieved complete axillary clinical response underwent SLNB. Those whose SLNs were negative were not subjected to additional ALND. The oncological outcomes of the patients were analyzed. RESULTS: Fifty-nine T1-T3 patients (45.0%) achieved a complete axillary response (cN0), and were selected to undergo SLNB. SLNs were detected in 55 of them (93.2%). Seventeen of those patients (30.9%) had SLN metastases detected and subsequently underwent ALND. In contrast, 38 patients (69.1%) had no nodal metastases detected and were managed without complementary ALND. After a mean follow-up of 55.8 months, only one patient (2.6%) submitted to SLNB without a complementary ALND had axillary recurrence as compared with three patients (3.2%) in the ALND group (p = 0.71). Distant recurrence occurred more frequently among patients submitted to ALND (92.1%) than among those only submitted to SLNB (7.9%) (p < 0.0006). Overall survival and disease-free survival were significantly better in patients who were not submitted to ALND. CONCLUSION: SLNB could be successfully used in guiding a more selective axillary approach in cN+ patients that became cN0 after NAC. Omitting ALND in CN0 patients with negative SLNs did not seem to compromise disease control and oncological outcomes.
PURPOSE: The role of sentinel lymph node biopsy (SLNB) in breast cancerpatients who undergo neoadjuvant chemotherapy (NAC) remains controversial. This study aims to investigate if axillary lymph node dissection (ALND) could be safely omitted after a negative SLNB in cN1/2patients who become cN0 after NAC. METHODS: We retrospectively assessed T1-4, cN1/2patients who were submitted to NAC between 2010 and 2016. T1-T3 patients who achieved complete axillary clinical response underwent SLNB. Those whose SLNs were negative were not subjected to additional ALND. The oncological outcomes of the patients were analyzed. RESULTS: Fifty-nine T1-T3 patients (45.0%) achieved a complete axillary response (cN0), and were selected to undergo SLNB. SLNs were detected in 55 of them (93.2%). Seventeen of those patients (30.9%) had SLN metastases detected and subsequently underwent ALND. In contrast, 38 patients (69.1%) had no nodal metastases detected and were managed without complementary ALND. After a mean follow-up of 55.8 months, only one patient (2.6%) submitted to SLNB without a complementary ALND had axillary recurrence as compared with three patients (3.2%) in the ALND group (p = 0.71). Distant recurrence occurred more frequently among patients submitted to ALND (92.1%) than among those only submitted to SLNB (7.9%) (p < 0.0006). Overall survival and disease-free survival were significantly better in patients who were not submitted to ALND. CONCLUSION: SLNB could be successfully used in guiding a more selective axillary approach in cN+ patients that became cN0 after NAC. Omitting ALND in CN0 patients with negative SLNs did not seem to compromise disease control and oncological outcomes.
Authors: C S Pinto; B Peleteiro; C A Pinto; F Osório; S Costa; A Magalhães; H Mora; J Amaral; D Gonçalves; J L Fougo Journal: Breast Cancer Date: 2022-03-19 Impact factor: 3.307