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Outcome following sentinel lymph node biopsy-guided decisions in breast cancer patients with conversion from positive to negative axillary lymph nodes after neoadjuvant chemotherapy

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Abstract

Purpose

Many breast cancer patients with positive axillary lymph nodes achieve complete node remission after neoadjuvant chemotherapy. The usefulness of sentinel lymph node biopsy in this situation is uncertain. This study evaluated the outcomes of sentinel biopsy-guided decisions in patients who had conversion of axillary nodes from clinically positive to negative following neoadjuvant chemotherapy.

Methods

We reviewed the records of 1247 patients from five hospitals in Korea who had breast cancer with clinically axillary lymph node-positive status and negative conversion after neoadjuvant chemotherapy, between 2005 and 2012. Patients who underwent axillary operations with sentinel biopsy-guided decisions (Group A) were compared with patients who underwent complete axillary lymph node dissection without sentinel lymph node biopsy (Group B). Axillary node recurrence and distant recurrence-free survival were compared.

Results

There were 428 cases in Group A and 819 in Group B. Kaplan–Meier analysis showed that recurrence-free survivals were not significantly different between Groups A and B (4-year axillary recurrence-free survival: 97.8 vs. 99.0%; p = 0.148). Multivariate analysis also indicated the two groups had no significant difference in axillary and distant recurrence-free survival.

Conclusions

For breast cancer patients who had clinical conversion of axillary lymph nodes from positive to negative following neoadjuvant chemotherapy, sentinel biopsy-guided axillary surgery, and axillary lymph node dissection without sentinel lymph node biopsy had similar rates of recurrence. Thus, sentinel biopsy-guided axillary operation in breast cancer patients who have clinically axillary lymph node positive to negative conversion following neoadjuvant chemotherapy is a useful strategy.

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Author notes

  1. Young-Joon Kang and Wonshik Han have contributed equally to this study.

Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Young-Joon Kang, Wonshik Han & Dong-Young Noh

  2. Cancer Biostatistics Branch, Research Institute for National Cancer Control and Evaluation, Research Institute and Hospital, National Cancer Center, Goyang, Korea

    Soojin Park, Ji Young You & Eun Sook Lee

  3. Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Ha Woo Yi, Sungmin Park & Jeong Eon Lee

  4. Department of Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea

    Sanggeun Nam, Joo Heung Kim & Seho Park

  5. Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea

    Keong Won Yun, Hee Jeong Kim, Sei Hyun Ahn & Jong Won Lee

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  1. Young-Joon Kang
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Corresponding author

Correspondence to Jong Won Lee.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kang, YJ., Han, W., Park, S. et al. Outcome following sentinel lymph node biopsy-guided decisions in breast cancer patients with conversion from positive to negative axillary lymph nodes after neoadjuvant chemotherapy. Breast Cancer Res Treat 166, 473–480 (2017). https://doi.org/10.1007/s10549-017-4423-1

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