Journal List > J Breast Cancer > v.10(4) > 1036079

Park, Lee, Yang, Park, and Han: Sentinel Lymph Node Biopsy in Patients with Clinically Negative Lymph Node After Neoadjuvant Chemotherapy

Abstract

Purpose

We wanted to evaluate the accuracy of sentinel lymph node biopsy (SLNB) in patients with clinically negative lymph node after neoadjuvant chemotherapy.

Methods

Fifty-nine women underwent 4 cycles of neoadjuvant chemotherapy with epirubicin (75 mg/m²) plus docetaxel (75 mg/m²), or with doxorubicin (50 mg/m²), cyclophosphamide (600 mg/m²) and 5-fluorouracil (500 mg/m²) for their primary breast cancer. Their median age was 41 yr (range: 29-62) and all the tumors were larger than 3 cm in maximum diameter. SLNB was performed 3 min after periareolar injection of 1% isosulfan blue dye. All the patients underwent lymph node dissection at the level 1 and 2 axillary areas irrespective of their nodal status.

Results

A clinical response after neoadjuvant chemotherapy was observed in 46 patients (88%) and 11 (18.7%) patients had a complete pathologic response. Thirty-five patients (62.7%) underwent breast conserving surgery. The sentinel lymph node was identified in 96.6% and the median number of sentinel nodes was 3 (range: 1-6). The median number of dissected nodes was 14 (range: 11-47). Metastasis to the lymph node was observed in 56% of the patients. The sentinel lymph node was the only metastatic node in 12 patients. Three patients with a negative sentinel lymph node were confirmed to have metastasis to non-sentinel nodes after the final histologic examination (false negative rate: 9.1%). The overall accuracy of SLNB was 94.7%.

Conclusion

SLNB after neoadjuvant chemotherapy was a safe method in patients with clinically negative lymph node.

Figures and Tables

Table 1
Results of sentinel node biopsy after chemotherapy
jbc-10-254-i001

SLN=sentinel lymph node; LN=lymph node.

Table 2
Comparison of sentinel lymph node status with final histologic diagnosis
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False negative rate, 9.1% (3/33); Negative predictive value, 88.9% (24/27); Accuracy, 94.7% (54/57).

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