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Is Low-Volume Disease in the Sentinel Node After Neoadjuvant Chemotherapy an Indication for Axillary Dissection?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 21 February 2020

This article has been updated

Abstract

Background/Objective

Intraoperative evaluation of sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) has a higher false-negative rate than in the primary surgical setting, particularly for small tumor deposits. Additional tumor burden seen with isolated tumor cells (ITCs) and micrometastases following primary surgery is low; however, it is unknown whether the same is true after NAC. We examined the false-negative rate of intraoperative frozen section (FS) after NAC, and the association between SLN metastasis size and residual disease at axillary lymph node dissection (ALND).

Methods

Patients undergoing SLN biopsy after NAC were identified. The association between SLN metastasis size and residual axillary disease was examined.

Results

From July 2008 to July 2017, 702 patients (711 cancers) had SLN biopsy after NAC. On FS, 181 had metastases, 530 were negative; 33 negative cases were positive on final pathology (false-negative rate 6.2%). Among patients with a positive FS, 3 (2%) had ITCs and no further disease on ALND; 41 (23%) had micrometastases and 125 (69%) had macrometastases. Fifty-nine percent of patients with micrometastases and 63% with macrometastases had one or more additional positive nodes at ALND. Among those with a false-negative result, 10 (30%) had ITCs, 15 (46%) had micrometastases, and 8 (24%) had macrometastases; 17 had ALND and 59% had one or more additional positive lymph nodes. Overall, 1/6 (17%) patients with ITCs and 28/44 (64%) patients with micrometastases had additional nodal metastases at ALND.

Conclusion

Low-volume SLN disease after NAC is not an indicator of a low risk of additional positive axillary nodes and remains an indication for ALND, even when not detected on intraoperative FS.

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Change history

  • 21 February 2020

    The following are corrections to the original article.

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Disclosures

Tracy-Ann Moo, Marcia Edelweiss, Sabina Hajiyeva, Michelle Stempel, Monica Raiss, Emily C. Zabor, Andrea Barrio, and Monica Morrow have no conflicts of interest disclosures to report.

Funding

The preparation of this study was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Tracy-Ann Moo MD, Michelle Stempel MPH, Monica Raiss BA, Andrea Barrio MD & Monica Morrow MD

  2. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Marcia Edelweiss MD & Sabina Hajiyeva MD

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Emily C. Zabor MS

Authors
  1. Tracy-Ann Moo MD
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  2. Marcia Edelweiss MD
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  3. Sabina Hajiyeva MD
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Correspondence to Monica Morrow MD.

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Moo, TA., Edelweiss, M., Hajiyeva, S. et al. Is Low-Volume Disease in the Sentinel Node After Neoadjuvant Chemotherapy an Indication for Axillary Dissection?. Ann Surg Oncol 25, 1488–1494 (2018). https://doi.org/10.1245/s10434-018-6429-2

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  • DOI: https://doi.org/10.1245/s10434-018-6429-2

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