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Clipping a Positive Lymph Node Improves Accuracy of Nodal Staging After Neoadjuvant Chemotherapy for Breast Cancer Patients, but Does It Drive Management Changes?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node (SLN) biopsy for cN+ breast cancer patients after neoadjuvant chemotherapy (NAC) is controversial because the false-negative rate (FNR) is high. Identification of three or more SLNs with a dual tracer improves these results, and inclusion of a clipped lymph node (CLN) (targeted axillary dissection [TAD]) may be even more effective.

Methods

A retrospective, single-institution analysis of consecutive cN+ patients undergoing NAC from 2019 to 2021 was performed. Patients routinely underwent placement of a clip in the positive lymph node before NAC, and TAD was performed after completion of therapy.

Results

The study analyzed 73 patients, and the identification rate for CLN was 98.6% (72/73). A complete response in the lymph nodes was achieved for 43 (59%) of the 73 patients. Overall, the CLN was not a SLN in 18 (25%) of 73 cases, and for women who had one or two and those who had three or more SLNs identified, this occurred in 11 (32%) and 7 (21%) of 34 cases, respectively. Failure of SLN or TAD to identify a positive residual lymph node status after NAC occurred in 10 (15%) of 69 and 2 (3%) of 73 cases, respectively (p = 0.01). In four cases, a SLN was not retrieved (5.5%), and two of these cases had a positive CLN. In three cases, the CLN was the only positive node and did not match with a SLN, directing lymphadenectomy and oncologic management change in two cases. Therefore, 7 (10%) of 73 cases had a change in surgical or oncologic management with TAD.

Conclusions

For a conservative axillary treatment in this setting, TAD is an effective method. It is more accurate than SLN alone and allows management changes. Further studies are warranted.

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Acknowledgments

This work was supported by Fondazione Prometeus, ONLUS, for the development of research and training in oncology. The authors thank Marcia Jane Adams for English assistance in the preparation of the manuscript.

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Authors and Affiliations

  1. Breast Center, San Giovanni-Addolorata Hospital, Rome, Italy

    Leopoldo Costarelli MD, Francesca Arienzo MD, Laura Broglia MD, Massimo La Pinta MD, Paola Scavina MD, Emanuele Zarba Meli MD, Maria Helena Colavito MD, Alessandra Ascarelli MD, Domenico Campagna MD, Tiziana Mastropietro MD, Elena Manna MD, Michela Amato MD, PhD, Angela Damiana Andrulli MD, Alfonso Schiavone MD, Mauro Minelli MD & Lucio Fortunato MD

  2. Pathology Unit, San Giovanni-Addolorata Hospital, Rome, Italy

    Leopoldo Costarelli MD, Francesca Arienzo MD, Domenico Campagna MD & Michela Amato MD, PhD

  3. Breast Radiology, San Giovanni-Addolorata Hospital, Rome, Italy

    Laura Broglia MD, Maria Helena Colavito MD & Alessandra Ascarelli MD

  4. Breast Surgery, San Giovanni-Addolorata Hospital, Rome, Italy

    Massimo La Pinta MD, Emanuele Zarba Meli MD, Tiziana Mastropietro MD, Elena Manna MD, Alfonso Schiavone MD & Lucio Fortunato MD

  5. Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy

    Paola Scavina MD & Mauro Minelli MD

  6. Radiotherapy Unit, San Giovanni-Addolorata Hospital, Rome, Italy

    Angela Damiana Andrulli MD

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Costarelli, L., Arienzo, F., Broglia, L. et al. Clipping a Positive Lymph Node Improves Accuracy of Nodal Staging After Neoadjuvant Chemotherapy for Breast Cancer Patients, but Does It Drive Management Changes?. Ann Surg Oncol 31, 3186–3193 (2024). https://doi.org/10.1245/s10434-024-15052-y

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