Nodal positivity in patients with clinically and radiologically node-negative breast cancer treated with neoadjuvant chemotherapy: multicentre collaborative study

The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopatholo...

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Bibliographic Details
Published in:British journal of surgery 2024-01, Vol.111 (1)
Main Authors: Zaborowski, Alexandra M, Doogan, Katie, Clifford, Siobhan, Dowling, Gavin, Kazi, Farah, Delaney, Karina, Yadav, Himanshu, Brady, Aaron, Geraghty, James, Evoy, Denis, Rothwell, Jane, McCartan, Damian, Heeney, Anna, Barry, Mitchel, Walsh, Siun M, Stokes, Maurice, Kell, Malcolm R, Allen, Michael, Power, Colm, Hill, Arnold D K, Connolly, Elizabeth, Alazawi, Dhafir, Boyle, Terence, Corrigan, Mark, O'Leary, Peter, Prichard, Ruth S
Format: Article
Language:English
Subjects:
Axilla - pathology
Breast Neoplasms - diagnostic imaging
Breast Neoplasms - drug therapy
Breast Neoplasms - pathology
Female
Hormones - therapeutic use
Humans
Lymph Node Excision
Lymph Nodes - diagnostic imaging
Lymph Nodes - pathology
Neoadjuvant Therapy
Original
Sentinel Lymph Node Biopsy
Triple Negative Breast Neoplasms - diagnostic imaging
Triple Negative Breast Neoplasms - drug therapy
Triple Negative Breast Neoplasms - pathology
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Summary:The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopathological features associated with lymph node metastasis after neoadjuvant chemotherapy (ypN+). A retrospective multicentre study was performed. Patients with cT1-3 cN0 breast cancer who underwent sentinel lymph node biopsy after neoadjuvant chemotherapy between 2016 and 2021 were included. Negative nodal status was defined as the absence of palpable lymph nodes, and the absence of suspicious nodes on axillary ultrasonography, or the absence of tumour cells on axillary nodal fine needle aspiration or core biopsy. A total of 371 patients were analysed. Overall, 47 patients (12.7%) had a positive sentinel lymph node biopsy. Nodal positivity was identified in 22 patients (29.0%) with hormone receptor+/human epidermal growth factor receptor 2- tumours, 12 patients (13.8%) with hormone receptor+/human epidermal growth factor receptor 2+ tumours, 3 patients (5.6%) with hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 10 patients (6.5%) with triple-negative breast cancer. Multivariable logistic regression analysis showed that multicentric disease was associated with a higher likelihood of ypN+ (OR 2.66, 95% c.i. 1.18 to 6.01; P = 0.018), whilst a radiological complete response in the breast was associated with a reduced likelihood of ypN+ (OR 0.10, 95% c.i. 0.02 to 0.42; P = 0.002), regardless of molecular subtype. Only 3% of patients who had a radiological complete response in the breast were ypN+. The majority of patients (85%) with a positive sentinel node proceeded to axillary lymph node dissection and 93% had N1 disease. The rate of sentinel lymph node positivity in patients who achieve a radiological complete response in the breast is exceptionally low for all molecular subtypes.
ISSN:1365-2168
0007-1323
1365-2168
DOI:10.1093/bjs/znad401