Excision of both pretreatment marked positive nodes and sentinel nodes improves axillary staging after neoadjuvant systemic therapy in breast cancer

Background Marking the axilla with radioactive iodine seed and sentinel lymph node (SLN) biopsy have been proposed for axillary staging after neoadjuvant systemic therapy in clinically node‐positive breast cancer. This study evaluated the identification rate and detection of residual disease with co...

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Bibliographic Details
Published in:British journal of surgery 2019-11, Vol.106 (12), p.1632-1639
Main Authors: Simons, J. M., van Pelt, M. L. M. A., Marinelli, A. W. K. S., Straver, M. E., Zeillemaker, A. M., Pereira Arias‐Bouda, L. M., van Nijnatten, T. J. A., Koppert, L. B., Hunt, K. K., Smidt, M. L., Luiten, E. J. T., van der Pol, C. C.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Axilla - pathology
Biopsy
Breast
Breast cancer
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Female
Humans
Identification
Iodine
Lymph Node Excision - methods
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphatic Metastasis
Lymphatic system
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Original
Radiotherapy, Adjuvant
Retrospective Studies
Sentinel Lymph Node - pathology
Sentinel Lymph Node - surgery
Sentinel Lymph Node Biopsy
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Summary:Background Marking the axilla with radioactive iodine seed and sentinel lymph node (SLN) biopsy have been proposed for axillary staging after neoadjuvant systemic therapy in clinically node‐positive breast cancer. This study evaluated the identification rate and detection of residual disease with combined excision of pretreatment‐positive marked lymph nodes (MLNs) together with SLNs. Methods This was a multicentre retrospective analysis of patients with clinically node‐positive breast cancer undergoing neoadjuvant systemic therapy and the combination procedure (with or without axillary lymph node dissection). The identification rate and detection of axillary residual disease were calculated for the combination procedure, and for MLNs and SLNs separately. Results At least one MLN and/or SLN(s) were identified by the combination procedure in 138 of 139 patients (identification rate 99·3 per cent). The identification rate was 92·8 per cent for MLNs alone and 87·8 per cent for SLNs alone. In 88 of 139 patients (63·3 per cent) residual axillary disease was detected by the combination procedure. Residual disease was shown only in the MLN in 20 of 88 patients (23 per cent) and only in the SLN in ten of 88 (11 per cent), whereas both the MLN and SLN contained residual disease in the remainder (58 of 88, 66 per cent). Conclusion Excision of the pretreatment‐positive MLN together with SLNs after neoadjuvant systemic therapy in patients with clinically node‐positive disease resulted in a higher identification rate and improved detection of residual axillary disease. Antecedentes En el cáncer de mama con ganglios positivos clínicamente tras el tratamiento neoadyuvante sistémico, se ha propuesto la utilización de iodo radioactivo (Marking Axilla with Radioactive Iodine, MARI) y de la biopsia de ganglio linfático centinela para la estadificación axilar. En este estudio se evaluó la tasa de identificación y detección de enfermedad residual cuando se combinó la exéresis de los ganglios linfáticos marcados antes del tratamiento (marked lymph nodes, MLN) junto con los ganglios centinela (sentinel lymph nodes, SLN). Métodos Se realizó un análisis retrospectivo multicéntrico de pacientes con cáncer de mama con ganglios positivos clínicamente que se sometieron a tratamiento neoadyuvante sistémico y en las que se combinaron ambas técnicas (con o sin disección axilar). Se calcularon las tasas de identificación y detección de enfermedad residual axilar para MLN y SLN por separado
ISSN:0007-1323
1365-2168
1365-2168
DOI:10.1002/bjs.11320