Skip to main content
SpringerLink
Log in

Efficacy of sentinel lymph-node biopsy after neoadjuvant chemotherapy in clinically axilla node-negative patients

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Breast cancer is the most common cancer in women. Developments in breast cancer treatment have extended the life expectancy of these patients, raising the issue of morbidity of breast cancer surgery, the major cause of which is axillary dissection. The aim of the present study was to establish the safety of sentinel node biopsy (SLNB) in patients with a clinically node-negative axilla after neoadjuvant chemotherapy (NACT).

Methods

We recorded demographic data, as well as the findings of physical examination, imaging, and pathology before and after NACT. SLNB with indocyanine green + isosulfan blue and axillary dissection were performed and the surgical and pathology findings were recorded.

Results

A sentinel lymph node was detected in 80 of 90 patients who underwent surgery. When ≥ three sentinel lymph nodes were removed as negative in the patient group with cN0 after treatment, we evaluated the axilla as being negative with an accuracy of 100%.

Conclusions

Axillary lymph-node dissection may not be necessary for patients with cNO confirmed by physical and radiological examination using positron emission tomography (PET) computed tomography (CT), and breast magnetic resonance imaging (MRI) after NACT, if ≥ three negative SLNB are removed. Further studies are needed to confirm our findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

    Article  PubMed  Google Scholar 

  2. Yang Y, Liu G, Qin L, Ye L, Zhu F, Ying Y. Overexpression of UHRF1 and its potential role in the development of invasive ductal breast cancer validated by integrative bioinformatics and immunohistochemistry analyses. Transl Cancer Res. 2019;8(4):1086–96.

    Article  PubMed  PubMed Central  Google Scholar 

  3. De Meric de Bellefon M, Lemanski C, Ducteil A, Fenoglietto P, Azria D, Bourgier C. Management of the axilla in the era of breast cancer heterogeneity. Front Oncol. 2018;8:84.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Peek MCL, Saeki K, Ohashi K, Chikaki S, Baker R, Nakagawa T, et al. Optimization of SPIO injection for sentinel lymph node dissection in a rat model. Cancers (Basel). 2021;13(19):5031.

    Article  CAS  PubMed  Google Scholar 

  6. Citgez B, Yigit B, Yetkin SG. Management of the axilla and the breast after neoadjuvant chemotherapy in patients with breast cancer: a systematic review. Med Bull SisliEtfal Hospital. 2021;55(2):156.

    Google Scholar 

  7. Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al. Alliance for Clinical Trials in Oncology. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Cao S, Liu X, Cui J, Liu X, Zhong J, Yang Z, et al. Feasibility and reliability of sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients with positive axillary nodes at initial diagnosis: an up-to-date meta-analysis of 3,578 patients. Breast. 2021;59:256–69.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Guo J, Yang H, Wang S, Cao Y, Liu M, Xie F, et al. Comparison of sentinel lymph node biopsy guided by indocyanine green, blue dye, and their combination in breast cancer patients: a prospective cohort study. World J Surg Oncol. 2017;15(1):196.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chirappapha P, Chatmongkonwat T, Lertsithichai P, Pipatsakulroj W, Sritara C, Sukarayothin T. Sentinel lymph node biopsy after neoadjuvant treatment of breast cancer using blue dye, radioisotope, and indocyanine green: prospective cohort study. Ann Med Surg (Lond). 2020;59:156–60.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tsuyuki S, Yamaguchi A, Kawata Y, Kawaguchi K. Assessing the effects of neoadjuvant chemotherapy on lymphatic pathways to sentinel lymph nodes in cases of breast cancer: usefulness of the indocyanine green-fluorescence method. Breast. 2015;24(3):298–301.

    Article  PubMed  Google Scholar 

  12. Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, et al. Sentinel-lymph-nodebiopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentrecohortstudy. LancetOncol. 2013;14(7):609–18.

    Google Scholar 

  13. Sancar BAYAR, Seher DEMİRER Lokal İleri Meme Kanserinde Cerrahi Tedavi TürkiyeCumhuriyetiSağlıkBakanlığıSağlıkHizmetleriGenelMüdürlüğü, Meme KanseriKorunma, Tarama, Tanı, TedaviveİzlemKlinikRehberi (Versiyon 1.0, Ankara, 2020p. 68)

  14. Boileau JF, Poirier B, Basik M, Holloway CM, Gaboury L, Sideris L, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J ClinOncol. 2015;33(3):258–64.

    Article  Google Scholar 

  15. Kang SH, Kang JH, Choi EA, Lee ES. Sentinel lymph node biopsy after neoadjuvant chemotherapy. Breast Cancer. 2004;11(3):233–41 (discussion 264-6).

    Article  PubMed  Google Scholar 

  16. Ozmen V, Unal ES, Muslumanoglu ME, Igci A, Canbay E, Ozcinar B, et al. Axillary sentinel node biopsy after neoadjuvant chemotherapy. Eur J SurgOncol. 2010;36(1):23–9.

    Article  CAS  Google Scholar 

  17. Kahler-Ribeiro-Fontana S, Pagan E, Magnoni F, Vicini E, Morigi C, Corso G, et al. Long-term standard sentinel node biopsy after neoadjuvant treatment in breast cancer: a single institution ten-year follow-up. Eur J Surg Oncol. 2021;47(4):804–12.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. İstanbul Bağcılar Training and Research Hospital, General Surgery Clinic, İstanbul, Turkey

    Atilla Çelik

  2. General Surgery, Şanlıurfa Suruç State Hopital, Suruç, Turkey

    Fikret Çalıkoğlu

  3. Faculty of Medicine, Karadeniz Technical University, General Surgery Clinic, Ortahisar, Turkey

    Ahmet Akbaş

  4. İstanbul Sultan Abdülhamid Han Training and Research Hospital, General Surgery Clinic, İstanbul, Turkey

    Gülçin Ercan

  5. İstanbul Bağcılar Training and Research Hospital, Medical Pathology Clinic, İstanbul, Turkey

    Ali Muhammedoğlu

Authors
  1. Atilla Çelik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fikret Çalıkoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmet Akbaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gülçin Ercan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Muhammedoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fikret Çalıkoğlu.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare in association with this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Çelik, A., Çalıkoğlu, F., Akbaş, A. et al. Efficacy of sentinel lymph-node biopsy after neoadjuvant chemotherapy in clinically axilla node-negative patients. Surg Today (2024). https://doi.org/10.1007/s00595-024-02837-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00595-024-02837-7

Keywords

Search

Navigation