Posted by: bcconnections | February 22, 2013

The sentinel lymph node biopsy and neoadjuvant chemotherapy

Sentinel lymph node biopsy (SLNB) is an established technique to accurately assess the status of the axillary lymph nodes in women who undergo surgery for breast cancer.  This technique often spares women from a full axillary lymph node dissection.  For women who have chemotherapy prior to surgery (neoadjuvant chemotherapy), however, it is unknown whether the SLNB accurately reflects the lymph node status.

The ACOSOG Z1071 trial investigated the accuracy of the SLNB post-neoadjuvant chemotherapy.  The trial enrolled 756 women with clinically positive lymph nodes who underwent chemotherapy prior to surgery.  At the time of surgery, a SLNB was performed, followed by removal of all of the axillary lymph nodes.  SLNB correctly identified the nodal status in 91.2 percent of patients.  In 12.6 percent of patients, the SLNB was negative, but disease was found in other axillary lymph nodes.  This false-negative rate is higher than the 10 percent false-negative rate considered safe by the study standards. Better accuracy was obtained when three or more sentinel lymph nodes were identified, and when the SLNB was performed with both a blue dye and a radioactive tracer.  In a related trial, the SENTINA trial, the false-negative rate for a sentinel lymph node biopsy performed after neoadjuvant chemotherapy was 14.2 percent.

Sources:

“The role of sentinel lymph node surgery in patients presenting with node positive breast cancer (T0-T4, N1-2) who receive neoadjuvant chemotherapy – results from the ACOSOG Z1071 trial.”  Oughey JC et al.  The San Antonio Breast Cancery Symposium, 2012, Abstract S2-1.

“Sentinel lymph node biopsy before or after neoadjuvant chemotherapy – final results from the prospective German, multiinstitutional SENTINA-trial.”  Kuehn T et al.  The San Antonio Breast Cancery Symposium, 2012, Abstract S2-2.

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