Annals of Surgical Oncology

, Volume 10, Issue 6, pp 616–621 | Cite as

Lymphatic Mapping and Sentinel Lymphadenectomy After Preoperative Therapy for Stage II and III Breast Cancer

  • Glen C. Balch
  • Suhail K. Mithani
  • Ken R. Richards
  • R. Daniel Beauchamp
  • Mark C. Kelley
Original Articles

Abstract

Background: We evaluated the accuracy of sentinel lymph node dissection (SLND) in patients with stage II and III breast cancer who had received preoperative therapy.

Methods: A prospective clinical trial evaluated 122 patients who had SLND followed by axillary lymph node dissection. Thirty-two women had stage II or III breast cancer and received preoperative doxorubicin-based chemotherapy or paclitaxel and radiotherapy.

Results: A sentinel lymph node (SLN) was identified in 31 (97%) of 32 patients. The SLN predicted the status of the axillary nodes in 30 (97%) of 31 patients. Eighteen (58%) of 31 had metastases in the SLN. Eighteen of 19 patients with axillary metastases had a tumor-positive SLN (sensitivity, 95%; false-negative rate, 5%). Eight (44%) of 18 women with metastases in the SLN also had metastases in 1 or more nonsentinel nodes.

Conclusions: In this relatively small study, the accuracy of SLND in women with stage II or III breast cancer treated with preoperative therapy was similar to that achieved in early-stage breast cancer. If these results are confirmed in a larger cohort, it may be feasible to substitute SLND for routine axillary lymph node dissection in this population. This approach could reduce the morbidity of surgical therapy while preserving the accuracy of axillary staging and maintaining regional control in this high-risk population.

Key Words

Breast cancer Lymphatic mapping Sentinel lymph node dissection Preoperative radiotherapy Preoperative chemotherapy 

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REFERENCES

  1. 1.
    Giuliano AE, Kirgan DM, Geunther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220:391–401.PubMedCrossRefGoogle Scholar
  2. 2.
    Giuliano AE, Dale PS, Turner RR, et al. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg 1995; 222:394–401.PubMedCrossRefGoogle Scholar
  3. 3.
    Giuliano AE, Jones RC, Brennan M, et al. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997; 15:2345–50.PubMedGoogle Scholar
  4. 4.
    Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996; 276:1818–22.PubMedCrossRefGoogle Scholar
  5. 5.
    O’Hea BJ, Hill AD, El-Shirbiny AM, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg 1998; 186:423–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Haigh PI, Guiliano AE. Role of sentinel lymph node dissection in breast cancer. Ann Med 2000; 32:51–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer: a multicenter validation study. N Engl J Med 1998; 339:941–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Cox CE, Bass SS, McCann CR, et al. Lymphatic mapping and sentinel lymph node biopsy in patients with breast cancer. Annu Rev Med 2000; 51:525–42.PubMedCrossRefGoogle Scholar
  9. 9.
    Giuliano AE, Haigh PI, Brennan MB, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 2000; 18:2553–9.PubMedGoogle Scholar
  10. 10.
    Cox CE, Pendas S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 1998; 227:645–51.PubMedCrossRefGoogle Scholar
  11. 11.
    Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from the National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 1997; 15:2483–93.PubMedGoogle Scholar
  12. 12.
    Anderson B, Jewell K, Eary J, et al. Neoadjuvant chemotherapy contraindicates sentinel node mapping in breast cancer (abstract). Proc Am Soc Clin Oncol 1999; 18:71a.Google Scholar
  13. 13.
    Nason KS, Anderson BO, Byrd DR, et al. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 2000; 89:2187–94.PubMedCrossRefGoogle Scholar
  14. 14.
    Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol 2000; 18:3480–6.PubMedGoogle Scholar
  15. 15.
    Mamounas E, Brown A, Smith R, et al. Sentinel node biopsy following neoadjuvant chemotherapy in breast cancer: results from NSABP B-27. Paper presented at: Society of Surgical Oncology 54th Annual Cancer Symposium; March 15–18, 2001; Washington, DC.Google Scholar
  16. 16.
    Julian TB, Patel N, Dusi D, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer. Am J Surg 2001; 182:407–10.PubMedCrossRefGoogle Scholar
  17. 17.
    Tafra L, Verbanac KM, Lannin DR. Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer. Am J Surg 2001; 182:312–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Chakravarthy A, Nicholson B, Kelley MC, et al. A pilot study of neoadjuvant paclitaxel and radiation with correlative molecular studies in stage II/III breast cancer. Clin Breast Cancer 2000; 1:68–20.PubMedCrossRefGoogle Scholar
  19. 19.
    Fleming ID, Cooper JS, Henson DE, et al, eds. AJCC Cancer Staging Manual. 5th ed. Philadelphia: Lippincott-Raven, 1997.Google Scholar
  20. 20.
    Feezor R, Kasraeian A, Copeland EM, et al. Sequential dermal-peritumoral radiocolloid injection for sentinel node biopsy for breast cancer: the University of Florida experience. Am Surg 2002; 68:684–7.PubMedGoogle Scholar
  21. 21.
    Martin RC, Derossis AM, Fey J, et al. Intradermal isotope injection is superior to intramammary in sentinel node biopsy for breast cancer. Surgery 2001; 130:432–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Mamounas EP, Fisher B. Preoperative (neoadjuvant) chemotherapy in patients with breast cancer. Semin Oncol 2001; 4:389–99.CrossRefGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2003

Authors and Affiliations

  • Glen C. Balch
    • 1
  • Suhail K. Mithani
    • 1
  • Ken R. Richards
    • 1
  • R. Daniel Beauchamp
    • 1
  • Mark C. Kelley
    • 1
    • 2
  1. 1.Division of Surgical OncologyVanderbilt University Medical CenterNashville
  2. 2.Vanderbilt University Medical CenterNashville

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