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Annals of Surgical Oncology

, Volume 23, Issue 11, pp 3475–3480 | Cite as

How Often Is Treatment Effect Identified in Axillary Nodes with a Pathologic Complete Response After Neoadjuvant Chemotherapy?

  • Andrea V. Barrio
  • Anita Mamtani
  • Marcia Edelweiss
  • Anne Eaton
  • Michelle Stempel
  • Melissa P. Murray
  • Monica Morrow
Breast Oncology

Abstract

Background

False-negative rates (FNR) of sentinel node biopsy (SNB) after neoadjuvant chemotherapy (NAC) in node-positive (N+) breast cancer patients are <10 % when ≥3 negative SNs are obtained. Marking positive nodes has been suggested to reduce FNR. Identification of treatment effect in the nodes post-NAC is an alternative to decrease FNR. We evaluated the frequency of treatment effect in N+ patients after a pathologic complete response (pCR) with NAC.

Methods

Biopsy-proven N+ patients receiving NAC were identified. Patients with nodal pCR after axillary lymph node dissection (ALND) or SNB with dual mapping and ≥3 SNs removed were evaluated for treatment effect; ALND and SNB patients were compared.

Results

From January 2009 to December 2015, 528 N+ patients received NAC. Of these, 204 had a nodal pCR, 135 had an ALND, and 69 had SNB. Median age was 49 years, 15 % were hormone receptor positive (HR+)/HER2−, 27 % triple negative, and 58 % HER2+. The median number of nodes removed in ALND patients was 17 versus 4 in SNB patients. Treatment effect in nodes was identified in 192 patients (94 %) and was more common in ALND versus SNB patients (97 vs 88 %; p = .02). HR+ patients and patients without a breast pCR were less likely to have treatment effect in the nodes (p = .05). Other characteristics did not differ.

Conclusions

Following NAC, SNs with treatment effect were retrieved in 88 % of patients without marking nodes, suggesting that nodal clipping may not be necessary to achieve an acceptable FNR. Longer follow-up is needed to determine regional recurrence rates in the SN-only cohort.

Keywords

Sentinel Node Biopsy Axillary Lymph Node Dissection Isosulfan Blue Sentinel Node Biopsy Group Regional Recurrence Rate 
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

Acknowledgment

This study was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 and presented in podium format at the 69th Society of Surgical Oncology Annual Cancer Symposium, March 2–5, 2016, Boston, MA.

Disclosures

The authors have no conflict of interest disclosures to report.

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Andrea V. Barrio
    • 1
  • Anita Mamtani
    • 1
  • Marcia Edelweiss
    • 2
  • Anne Eaton
    • 3
  • Michelle Stempel
    • 1
  • Melissa P. Murray
    • 2
  • Monica Morrow
    • 1
  1. 1.Breast Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of PathologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA

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