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Localizing Positive Axillary Lymph Nodes in Breast Cancer Patients Post Neoadjuvant Therapy.

Raeda Taj1, Sophie H Chung1, Nicole H Goldhaber1

  • 1Department of Surgery, University of California San Diego, San Diego, California.

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|November 24, 2022
PubMed
Summary

Identifying clipped lymph nodes after neoadjuvant chemotherapy is challenging. Radiologically abnormal nodes are more likely to be localized, but improved localization technology is needed for accurate sentinel lymph node biopsy (SLNB) after treatment.

Keywords:
Abnormal lymph nodesAxillary lymph node metastasisNeoadjuvant therapyPreoperative localizationSentinel lymph node biopsy

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Radiology

Background:

  • Sentinel lymph node biopsy (SLNB) is feasible after neoadjuvant chemotherapy (NAT).
  • Previous trials reported >10% false-negative rates for SLNB post-NAT.
  • Removing the clipped positive lymph node during SLNB reduces the false-negative rate to 6.8% post-NAT.

Purpose of the Study:

  • To examine factors influencing the identification of clipped lymph nodes after neoadjuvant therapy.
  • To improve the accuracy of sentinel lymph node biopsy in breast cancer patients undergoing neoadjuvant chemotherapy.

Main Methods:

  • Retrospective chart review of 80 breast cancer patients who underwent NAT, preoperative localization, and SLNB.
  • Comparison of demographic and preoperative variables between localized and non-localized groups.
  • Analysis of factors associated with successful localization of clipped lymph nodes post-NAT.

Main Results:

  • Only 49% of patients were successfully localized after NAT completion.
  • Ultrasound-detectable marker clips were localized in only half of the patients.
  • Radiologically abnormal lymph nodes post-NAT were significantly associated with successful localization (67%, OR 4.31, P=0.002).

Conclusions:

  • Radiologically abnormal lymph nodes post-NAT are more amenable to localization.
  • Lymph nodes that normalize on imaging present a significant localization challenge.
  • Preoperative localization before NAT and improved localization technology are suggested for enhanced accuracy.