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Annals of Surgical Oncology

, Volume 23, Issue 5, pp 1549–1553 | Cite as

Axillary Staging After Neoadjuvant Chemotherapy for Breast Cancer: A Pilot Study Combining Sentinel Lymph Node Biopsy with Radioactive Seed Localization of Pre-treatment Positive Axillary Lymph Nodes

  • Emilia J. DiegoEmail author
  • Priscilla F. McAuliffe
  • Atilla Soran
  • Kandace P. McGuire
  • Ronald R. Johnson
  • Marguerite Bonaventura
  • Gretchen M. Ahrendt
Breast Oncology

Abstract

Background

Neoadjuvant chemotherapy (NAC) downstages axillary disease in 55 % of node-positive (N1) breast cancer. The feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC for percutaneous biopsy-proven N1 patients who are clinically node negative (cN0) by physical examination after NAC is under investigation. ACOSOG Z1071 reported a false-negative rate of <10 % if ≥3 nodes are removed with dual tracer, including excision of the biopsy-proven positive lymph node (BxLN). We report our experience using radioactive seed localization (RSL) to retrieve the BxLN with SLNB (RSL/SLNB) for cN0 patients after NAC.

Methods

We performed a retrospective review of a single-institution, prospectively maintained registry for the years 2013 to 2014. Patients with BxLN who received NAC and had RSL/SLNB were identified. All BxLNs were marked with a radiopaque clip before NAC to facilitate RSL.

Results

Thirty patients with BxLN before NAC were cN0 after NAC and underwent RSL/SLNB. Median age was 55 years. Disease stage was IIA–IIIB. Twenty-nine of 30 had ductal cancer (12 triple negative and 16 HER-2 positive). One to 11 nodes were retrieved. Twenty-nine of 30 BxLN were successfully localized with RSL. Note was made of the BxLN-containing isotope and/or dye in 22 of 30. Nineteen patients had no residual axillary disease; 11 had persistent disease. All who remained node positive had disease in the BxLN.

Conclusions

RSL/SLNB is a promising approach for axillary staging after NAC in patients whose disease becomes cN0. The status of the BxLN after NAC predicted nodal status, suggesting that localization of the BxLN may be more accurate than SLNB alone for staging the axilla in the cN0 patient after NAC.

Keywords

Sentinel Lymph Node Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection Target Lymph Node 125I Seed 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

The authors declare no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Emilia J. Diego
    • 1
    Email author
  • Priscilla F. McAuliffe
    • 1
  • Atilla Soran
    • 1
  • Kandace P. McGuire
    • 2
  • Ronald R. Johnson
    • 1
  • Marguerite Bonaventura
    • 1
  • Gretchen M. Ahrendt
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of Pittsburgh College of Medicine, Magee Womens Hospital of UPMCPittsburghUSA
  2. 2.Division of Surgical Oncology, Department of SurgeryUniversity of North CarolinaChapel HillUSA

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