Swedish prospective multicenter trial evaluating sentinel lymph node biopsy after neoadjuvant systemic therapy in clinically node-positive breast cancer

被引:34
|
作者
Zetterlund, Linda Holmstrand [1 ,2 ]
Frisell, Jan [3 ,4 ]
Zouzos, Athanasios [5 ]
Axelsson, Rimma [6 ,7 ]
Hatschek, Thomas [8 ,9 ]
de Boniface, Jana [3 ,10 ]
Celebioglu, Fuat [1 ,2 ]
机构
[1] Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden
[2] Soder Sjukhuset, Dept Surg, S-11883 Stockholm, Sweden
[3] Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden
[4] Karolinska Univ Hosp, Dept Breast & Endocrine Surg, S-17176 Stockholm, Sweden
[5] Soder Sjukhuset, Dept Radiol, S-11883 Stockholm, Sweden
[6] Karolinska Inst, Div Radiog, Dept Clin Sci Intervent & Technol, Stockholm, Sweden
[7] Karolinska Univ Hosp Huddinge, Dept Radiol, S-14186 Stockholm, Sweden
[8] Karolinska Inst, Canc Ctr Karolinska, Dept Oncol, S-17176 Stockholm, Sweden
[9] Karolinska Univ Hosp, S-17176 Stockholm, Sweden
[10] Capio St Gorans Hosp, Dept Surg, S-11281 Stockholm, Sweden
关键词
Sentinel lymph node biopsy; Breast cancer; Neoadjuvant systemic therapy; False-negative rate; Identification rate; Node-positive; SURGICAL ADJUVANT BREAST; ACOSOG Z1071 ALLIANCE; RANDOMIZED MULTICENTER; AXILLARY DISSECTION; IDENTIFICATION RATE; CHEMOTHERAPY; DISEASE; SURGERY; LYMPHADENECTOMY; TRASTUZUMAB;
D O I
10.1007/s10549-017-4164-1
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Patients with clinically node-positive breast cancer planned for neoadjuvant systemic therapy (NAST) may draw advantages from the nodal downstaging effect and reduce the extent of axillary surgery with sentinel lymph node biopsy (SLNB) performed after NAST. Since there are concerns about lower sentinel lymph node (SLN) detection and higher false-negative rates (FNR) in this setting, our aim was to define the accuracy of SLNB after NAST. This Swedish national multicenter trial prospectively recruited 195 breast cancer patients from ten hospitals with T1-T4d biopsy-proven node-positive disease planned for NAST between October 1, 2010 and December 31, 2015. Clinically node-negative axillary status after NAST was not mandatory. SLNB was always attempted and followed by a completion axillary lymph node dissection (ALND). The SLN identification rate was 77.9% (152/195) but improved to 80.7% (138/171) with dual mapping. The median number of SLNs was two (range 1-5). A positive SLNB was found in 52% (79/152), almost 66% (52/79) of whom had additional positive non-sentinel lymph nodes. The overall pathologic nodal response rate was 33.3% (66/195). The overall FNR was 14.1% (13/92) but decreased to 4% (2/50) when only patients with two or more sentinel nodes were analyzed. In biopsy-proven node-positive breast cancer, SLNB after NAST is feasible even though the identification rate is lower than in clinically node-negative patients. Since the overall FNR is unacceptably high, the omission of ALND should only be considered if two or more SLNs are identified.
引用
收藏
页码:103 / 110
页数:8
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