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Oncologic Safety of Sentinel Lymph Node Biopsy Alone After Neoadjuvant Chemotherapy for Breast Cancer

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

Abstract

Background

The oncologic safety of sentinel lymph node biopsy (SLNB) alone for clinically node-positive (cN1–2) patients who convert to pathologic node-negativity (ypN0) after neoadjuvant chemotherapy (NAC) is not well established.

Methods

This study retrospectively identified 244 consecutive patients with a diagnosis of cT1–3cN0–2 breast cancer who underwent NAC followed by SLNB at the authors’ institution between 2013 and 2018. The patients were categorized as clinically node-negative (cN0) or cN1–2 before the onset of NAC, and the Kaplan–Meier method was used to compare locoregional and distant recurrence rates after SLNB alone for ypN0 patients.

Results

Among 244 patients who underwent NAC followed by surgery with SLNB for axillary staging, 112 (45.9%) were cN0 at presentation, whereas 132 (54.5%) had biopsy-proven cN1–2 disease and converted to cN0 after treatment. Of the patients presenting with cN0 disease, 102 (91.1%) were ypN0 on SLNB pathology compared with 60 cN1/2 patients (45.5%; p < 0.001). Regional nodal irradiation was administered to 5% of the cN0/ypN0 patients compared with 70.7% of the cN1–2/ypN0 patients (p < 0.001). Overall, 211 patients were treated with SLNB alone and had a median follow-up period of 36 months (interquartile range [IQR], 24–53 months). For 101 cN0/ypN0 patients who underwent SLNB alone, the 5-year local and regional recurrence rates were respectively 5.7% (95% confidence interval [CI], 2.4–13.8) and 1% (95% CI 0.1–7.0). For 58 cN1–2/ypN0 patients who underwent SLNB alone, the 5-year local and regional recurrence rates were respectively 4.1% (95% CI 1.0–15.5) and 0%, with no axillary recurrences noted.

Conclusion

For ypN0 patients, SLNB alone after NAC is associated with low and acceptable short-term axillary recurrence rates. Additional follow-up data from prospective clinical trials are needed to confirm long-term oncologic safety and define optimal local therapy recommendations.

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Authors and Affiliations

  1. Department of Surgical Oncology, McGill University Medical School, Montreal, QC, Canada

    Stephanie M. Wong MD, MPH, Mark Basik MD, Richard Margolese MD, Sinziana Dumitra MD, MSc & Jean Francois Boileau MD, MSc

  2. Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Canada

    Stephanie M. Wong MD, MPH, Mark Basik MD, Thierry Muanza MD & Cristiano Ferrario MD

  3. Department of Oncology, McGill University Medical School, Montreal, QC, Canada

    Mark Basik MD, Richard Margolese MD, Sinziana Dumitra MD, MSc, Thierry Muanza MD & Cristiano Ferrario MD

  4. Department of Pathology, McGill University Medical School, Montreal, QC, Canada

    Livia Florianova MD

  5. Department of Radiation Oncology, McGill University Medical School, Montreal, QC, Canada

    Thierry Muanza MD & Annie Carbonneau MD

Authors
  1. Stephanie M. Wong MD, MPH
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  2. Mark Basik MD
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  3. Livia Florianova MD
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  4. Richard Margolese MD
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  5. Sinziana Dumitra MD, MSc
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  9. Jean Francois Boileau MD, MSc
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Correspondence to Jean Francois Boileau MD, MSc.

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Wong, S.M., Basik, M., Florianova, L. et al. Oncologic Safety of Sentinel Lymph Node Biopsy Alone After Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 28, 2621–2629 (2021). https://doi.org/10.1245/s10434-020-09211-0

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  • DOI: https://doi.org/10.1245/s10434-020-09211-0

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