Minyan Chen1,2,3, Shengmei Li1,2,3, Meng Huang4, Jingjing Guo5, Xuan Huang5, Wenhui Guo1,2,3, Lili Chen1,2,3, Yuxiang Lin1,2,3, Lisa Jacobs6, Chuan Wang7,8,9, Fangmeng Fu10,11,12. 1. Department of Breast Surgery, Fujian Province, Fujian Medical University Union Hospital, Fuzhou, 350001, People's Republic of China. 2. Department of General Surgery, Fujian Province, Fujian Medical University Union Hospital, Fuzhou, 350001, People's Republic of China. 3. Fujian Province, Breast Cancer Institute, Fujian Medical University, Fuzhou, 350001, People's Republic of China. 4. Fujian Center For Disease Control and Prevention, Fuzhou, 350001, China. 5. Department of Ultrasound, Fujian Province, Fujian Medical University Union Hospital, Fuzhou, 350001, People's Republic of China. 6. Division of Surgical Oncology, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, USA. 7. Department of Breast Surgery, Fujian Province, Fujian Medical University Union Hospital, Fuzhou, 350001, People's Republic of China. dr_chuanwang@fjmu.edu.cn. 8. Department of General Surgery, Fujian Province, Fujian Medical University Union Hospital, Fuzhou, 350001, People's Republic of China. dr_chuanwang@fjmu.edu.cn. 9. Fujian Province, Breast Cancer Institute, Fujian Medical University, Fuzhou, 350001, People's Republic of China. dr_chuanwang@fjmu.edu.cn. 10. Department of Breast Surgery, Fujian Province, Fujian Medical University Union Hospital, Fuzhou, 350001, People's Republic of China. ffm@fjmu.edu.cn. 11. Department of General Surgery, Fujian Province, Fujian Medical University Union Hospital, Fuzhou, 350001, People's Republic of China. ffm@fjmu.edu.cn. 12. Fujian Province, Breast Cancer Institute, Fujian Medical University, Fuzhou, 350001, People's Republic of China. ffm@fjmu.edu.cn.
Abstract
PURPOSE: Current trials support the application of sentinel lymph node biopsy (SLNB) in node-positive breast cancer treated with neoadjuvant chemotherapy (NAC) with a lower false-negative rate (FNR) if dual-tracer (radioisotope and blue-dye) is used. However, radioisotopes are not available in many areas of the world. In this study, we evaluated the feasibility and accuracy of SLNB mapped with methylene-blue-dye alone. METHODS: This study enrolled 132 patients with biopsy-proven node-positive breast cancer with a clip placed in the positive node who then received NAC. After chemotherapy and before operation, all patients underwent axillary ultrasound (AUS) assessment and were classified as either negative (AUS-) or positive (AUS +) according to the axillary status. All patients underwent both SLNB and axillary lymph node dissection (ALND). SLNB was mapped with methylene-blue-dye alone. FNRs were evaluated on factors potentially affecting false-negative SLN finding. RESULTS: Using methylene-blue-dye alone, the FNR of SLNB was 9.9%. Post-NAC AUS assessment (p = 0.009) and the number of SLNs retrieved (p = 0.029) showed association with FNRs in multivariate analysis. In AUS- group, FNR was as low as 2.5%. In AUS + group, retrieving ≥ 4 SLNs including the clipped node improved FNR from 17.1% to 4.8%. A flowchart was designed with the combination of post-NAC AUS assessment, retrieved SLN number, and the retrieved of clipped node further improve overall FNR to 3.3%. CONCLUSION: In biopsy-proven node-positive breast cancer treated with NAC, using a flowchart to optimize patient selection reduces the FNR of single-tracer (methylene-blue-dye) guided SLNB.
PURPOSE: Current trials support the application of sentinel lymph node biopsy (SLNB) in node-positive breast cancer treated with neoadjuvant chemotherapy (NAC) with a lower false-negative rate (FNR) if dual-tracer (radioisotope and blue-dye) is used. However, radioisotopes are not available in many areas of the world. In this study, we evaluated the feasibility and accuracy of SLNB mapped with methylene-blue-dye alone. METHODS: This study enrolled 132 patients with biopsy-proven node-positive breast cancer with a clip placed in the positive node who then received NAC. After chemotherapy and before operation, all patients underwent axillary ultrasound (AUS) assessment and were classified as either negative (AUS-) or positive (AUS +) according to the axillary status. All patients underwent both SLNB and axillary lymph node dissection (ALND). SLNB was mapped with methylene-blue-dye alone. FNRs were evaluated on factors potentially affecting false-negative SLN finding. RESULTS: Using methylene-blue-dye alone, the FNR of SLNB was 9.9%. Post-NAC AUS assessment (p = 0.009) and the number of SLNs retrieved (p = 0.029) showed association with FNRs in multivariate analysis. In AUS- group, FNR was as low as 2.5%. In AUS + group, retrieving ≥ 4 SLNs including the clipped node improved FNR from 17.1% to 4.8%. A flowchart was designed with the combination of post-NAC AUS assessment, retrieved SLN number, and the retrieved of clipped node further improve overall FNR to 3.3%. CONCLUSION: In biopsy-proven node-positive breast cancer treated with NAC, using a flowchart to optimize patient selection reduces the FNR of single-tracer (methylene-blue-dye) guided SLNB.
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