Annals of Surgical Oncology

, Volume 9, Issue 3, pp 235–242

Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer

  • Vered Stearns
  • C. Alexander Ewing
  • Rebecca Slack
  • Marie F. Penannen
  • Daniel F. Hayes
  • Theodore N. Tsangaris
Original Articles

DOI: 10.1007/BF02573060

Cite this article as:
Stearns, V., Ewing, C.A., Slack, R. et al. Annals of Surgical Oncology (2002) 9: 235. doi:10.1007/BF02573060

Abstract

Background

After neoadjuvant chemotherapy, women with locally advanced breast cancer (LABC) undergo a modified radical mastectomy or lumpectomy with axillary lymph node dissection (ALND) and radiotherapy. Sentinel lymphadenectomy (SL) is accepted for axillary evaluation in early breast cancer. We assessed the feasibility and predictive value of SL after neoadjuvant chemotherapy.

Methods

Eligible women received neoadjuvant therapy for LABC and were scheduled to undergo a definitive surgical procedure. Vital blue dye SL was attempted followed by level I and II axillary dissection.

Results

SL was successful in 29 of 34 patients (detection rate, 85%). Thirteen patients (45%) had positive nodes, and eight (28%) had negative nodes on both SL and ALND. In five patients (17%), the sentinel node was the only positive node identified. Overall, there was a 90% concordance between SL and ALND. The false-negative rate and negative predictive value were 14% and 73%, respectively. Among the subgroup without inflammatory cancer, the detection and concordance rates were 89% and 96%, respectively. The false-negative rate was 6%, and the negative predictive value was 88%.

Conclusions

SL after neoadjuvant chemotherapy may reliably predict axillary staging except in inflammatory breast cancer. Further studies are required to assess the utility of SL as the only mode of axillary evaluation in these women.

Key Words

Locally advanced breast cancer Inflammatory breast cancer Neoadjuvant chemotherapy Sentinel lymph node mapping Sentinel lymphadenectomy 

Copyright information

© The Society of Surgical Oncology, Inc 2002

Authors and Affiliations

  • Vered Stearns
    • 1
  • C. Alexander Ewing
    • 2
  • Rebecca Slack
    • 1
    • 3
  • Marie F. Penannen
    • 4
  • Daniel F. Hayes
    • 1
  • Theodore N. Tsangaris
    • 4
  1. 1.Breast Cancer Program, Department of Oncology, Lombardi Cancer CenterGeorgetown University School of MedicineWashington, DC
  2. 2.Department of Pathology, Lombardi Cancer CenterGeorgetown University School of MedicineWashington, DC
  3. 3.Biostatistics Unit, Lombardi Cancer CenterGeorgetown University School of MedicineWashington, DC
  4. 4.Department of Surgery, Lombardi Cancer CenterGeorgetown University School of MedicineWashington, DC
  5. 5.University of Michigan Comprehensive Cancer CenterAnn Arbor