Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with node-positive breast cancer: guiding a more selective axillary approach

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.

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Funding

The authors have no financial relationships relevant to this article to disclose.

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Authors

Contributions

Conception and design: APD and JVB. Analysis and interpretation: APD, MZ, MPM. Data collection and analysis: APD, MZ, MPM. Writing the article: APD. Critical revision of the article: JVB. All authors have read and approved the final version of the article.

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Correspondence to Andrea P. Damin.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants followed the ethical standards of the institutional and national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All information was obtained from the electronic hospital records. Additional informed consent was also obtained from the hospital, where information and databases were collected. The researchers are committed to preserving the privacy of patients, and they also agree that the information was used exclusively to study. Research involving human participants for the retrospective cohort study, individual formal consent is not required.

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Damin, A.P., Zancan, M., Melo, M.P. et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with node-positive breast cancer: guiding a more selective axillary approach. Breast Cancer Res Treat 186, 527–534 (2021). https://doi.org/10.1007/s10549-020-06011-8

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Keywords

  • Breast cancer
  • Sentinel lymph node
  • Neo-adjuvant chemotherapy
  • Axillary lymph node dissection
  • Axillary staging