Prospective Evaluation of the Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Negative Axillary Conversion after Neoadjuvant Chemotherapy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose Tumor response to neoadjuvant chemotherapy (NAC) may adversely affect the identificationand accuracy rate of sentinel lymph node biopsy (SLNB). This study was conducted toevaluate the feasibility of SLNB in node-positive breast cancer patients with negative axillaryconversion after NAC. Materials and MethodsNinety-six patients with positive nodes at presentation were prospectively enrolled. 18Fluorodeoxyglucose-positron emission tomography (18F-FDG PET) and ultrasonographywere performed before and after NAC. A metastatic axillary lymph node was defined aspositive if it was positive upon both 18F-FDG PET and ultrasonography, while it was considerednegative if it was negative upon both 18F-FDG PET and ultrasonography. ResultsAfter NAC, 55 cases (57.3%) became clinically node-negative, while 41 cases (42.7%)remained node-positive. In the entire cohort, the sentinel lymph node (SLN) identificationand false-negative rates were 84.3% (81/96) and 18.4% (9/49), respectively. In thenegative axillary conversion group, the results of SLNB showed an 85.7% (48/55) identificationrate and 16.7% (4/24) false-negative rate. ConclusionFor breast cancer patients with clinically positive nodes at presentation, it is difficult toconclude whether the SLN accurately represents the metastatic status of all axillary lymphnodes, even after clinically negative node conversion following NAC.
Abstract
Purpose Tumor response to neoadjuvant chemotherapy (NAC) may adversely affect the identificationand accuracy rate of sentinel lymph node biopsy (SLNB). This study was conducted toevaluate the feasibility of SLNB in node-positive breast cancer patients with negative axillaryconversion after NAC. Materials and MethodsNinety-six patients with positive nodes at presentation were prospectively enrolled. 18Fluorodeoxyglucose-positron emission tomography (18F-FDG PET) and ultrasonographywere performed before and after NAC. A metastatic axillary lymph node was defined aspositive if it was positive upon both 18F-FDG PET and ultrasonography, while it was considerednegative if it was negative upon both 18F-FDG PET and ultrasonography. ResultsAfter NAC, 55 cases (57.3%) became clinically node-negative, while 41 cases (42.7%)remained node-positive. In the entire cohort, the sentinel lymph node (SLN) identificationand false-negative rates were 84.3% (81/96) and 18.4% (9/49), respectively. In thenegative axillary conversion group, the results of SLNB showed an 85.7% (48/55) identificationrate and 16.7% (4/24) false-negative rate. ConclusionFor breast cancer patients with clinically positive nodes at presentation, it is difficult toconclude whether the SLN accurately represents the metastatic status of all axillary lymphnodes, even after clinically negative node conversion following NAC.
참고문헌 (24)
- Giuliano AE, "Lymphatic mapping and sentinel lymphadenectomy for breast cancer", Ann Surg, 220, pp.391~398 (1994)
- Krag DN, "Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer : results from the NSABP B-32 randomised phase III trial", Lancet Oncol, 8, pp.881~888 (2007)
- Lyman GH, "American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer", J Clin Oncol, 23, pp.7703~7720 (2005)
- Schwartz GF, "Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania", Cancer, 94, pp.2542~2551 (2002)
- Fisher B, "Effect of preoperative chemotherapy on the outcome of women with operable breast cancer", J Clin Oncol, 16, pp.2672~2685 (1998)
- Xing Y, "Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer", Br J Surg, 93, pp.539~546 (2006)
- Rastogi P, "Preoperative chemotherapy : updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27", J Clin Oncol, 26, pp.778~785 (2008)
- Mohsin SK, "Neoadjuvant trastuzumab induces apoptosis in primary breast cancers", J Clin Oncol, 23, pp.2460~2468 (2005)
- Mamounas EP, "Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer : results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27", J Clin Oncol, 23, pp.2694~2702 (2005)
- Drew PJ, "Evaluation of response to neoadjuvant chemoradiotherapy for locally advanced breast cancer with dynamic contrast-enhanced MRI of the breast", Eur J Surg Oncol, 27, pp.617~620 (2001)
- Buchholz TA, "Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer : a National Cancer Institute conference", J Clin Oncol, 26, pp.791~797 (2008)
- Kinoshita T, "Sentinel lymph node biopsy is feasible for breast cancer patients after neoadjuvant chemotherapy", Breast Cancer, 14, pp.10~15 (2007)
- Shen J, "Feasibility and accuracy of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients with documented axillary metastases", Cancer, 109, pp.1255~1263 (2007)
- Lee S, "Sentinel node identification rate, but not accuracy, is significantly decreased after pre-operative chemotherapy in axillary node-positive breast cancer patients", Breast Cancer Res Treat, 102, pp.283~288 (2007)
- Newman EA, "Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation", Ann Surg Oncol, 14, pp.2946~2952 (2007)
- Boughey JC, "Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer : the ACOSOG Z1071(Alliance)clinical trial", JAMA, 310, pp.1455~1461 (2013)
- Kuehn T, "Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy(SENTINA) : a prospective, multicentre cohort study", Lancet Oncol, 14, pp.609~618 (2013)
- Ahn JH, "The role of ultrasonography and FDG-PET in axillary lymph node staging of breast cancer", Acta Radiol, 51, pp.859~865 (2010)
- Giuliano AE, "Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer", JAMA, 306, pp.385~393 (2011)
- "Clinical practice guidelines in oncology. Breast cancer guidelines, v.2.2012" (2012)[URL]
- Gil-Rendo A, "Fluorodeoxyglucose positron emission tomography with sentinel lymph node biopsy for evaluation of axillary involvement in breast cancer", Br J Surg, 93, pp.707~712 (2006)
- Cox CE, "Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer", Ann Surg, 227, pp.645~651 (1998)
- Cortazar P, "Meta-analysis results from the collaborative trials in neoadjuvant breast cancer (CTNeoBC)", Cancer Res, 72(24 Suppl 3), pp.S1~11 (2012)
- von Minckwitz G, "Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes", J Clin Oncol, 30, pp.1796~1804 (2012)