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Sentinel node biopsy prior to neoadjuvant chemotherapy.
Michael S Sabel1, Anne F Schott, Celina G Kleer
1Breast Oncology Program and Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA. msabel@umich.edu
American Journal of Surgery
|July 30, 2003
Summary
Performing sentinel lymph node biopsy (SLNB) before neoadjuvant chemotherapy accurately stages the axilla and avoids unnecessary surgery. This approach identifies node-positive patients, potentially reducing morbidity.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Management
Background:
- Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy has limitations including false negative rates and loss of pretreatment nodal staging.
- Pretreatment SLNB may overcome these limitations by providing accurate nodal staging before chemotherapy initiation.
Purpose of the Study:
- To evaluate the feasibility and accuracy of sentinel lymph node biopsy (SLNB) performed prior to neoadjuvant chemotherapy.
- To determine if pretreatment SLNB can accurately stage the axilla and potentially avoid axillary lymph node dissection (ALND).
Main Methods:
- Sentinel lymph node biopsy (SLNB) was conducted in clinically node-negative patients before starting chemotherapy.
- Axillary lymph node dissection (ALND) was performed only in patients with positive sentinel lymph nodes (SLNs).
Main Results:
- SLNB successfully identified the sentinel lymph node in 100% of 25 patients.
- 48% of patients were found to be node-negative, avoiding completion ALND.
- 60% of patients who underwent ALND had residual nodal disease.
- No surgical complications or delays in chemotherapy occurred.
Conclusions:
- Sentinel lymph node biopsy before neoadjuvant chemotherapy is accurate for axillary staging and avoids ALND morbidity.
- This strategy identifies node-positive patients who may benefit from further treatment planning based on residual disease status.