Nodal Recurrence in Patients With Node-Positive Breast Cancer Treated With Sentinel Node Biopsy Alone After Neoadjuvant Chemotherapy—A Rare Event

医学 乳腺癌 前哨淋巴结 腋窝淋巴结清扫术 活检 哨兵节点 前瞻性队列研究 腋窝 肿瘤科 内科学 癌症 外科 放射科 新辅助治疗
作者
Andrea V. Barrio,Giacomo Montagna,Anita Mamtani,Varadan Sevilimedu,Marcia Edelweiss,Deborah Capko,Hiram S. Cody,Mahmoud El‐Tamer,Mary L. Gemignani,Alexandra S. Heerdt,Laurie Kirstein,Tracy‐Ann Moo,Melissa Pilewskie,George Plitas,Virgilio Sacchini,Lisa M. Sclafani,Audree B. Tadros,Kimberly J. Van Zee
出处
期刊:JAMA Oncology [American Medical Association]
卷期号:7 (12): 1851-1851 被引量:67
标识
DOI:10.1001/jamaoncol.2021.4394
摘要

Importance

Prospective trials have demonstrated sentinel lymph node (SLN) false-negative rates of less than 10% when 3 or more SLNs are retrieved in patients with clinically node-positive breast cancer rendered clinically node-negative with neoadjuvant chemotherapy (NAC). However, rates of nodal recurrence in such patients treated with SLN biopsy (SLNB) alone are unknown because axillary lymph node dissection (ALND) was performed in all patients, limiting adoption of this approach.

Objective

To evaluate nodal recurrence rates in a consecutive cohort of patients with clinically node-positive (cN1) breast cancer receiving NAC, followed by a negative SLNB using a standardized technique, and no further axillary surgery.

Design, Setting, and Participants

From November 2013 to February 2019, a cohort of consecutively identified patients with cT1 to cT3 biopsy-proven N1 breast cancer rendered cN0 by NAC underwent SLNB with dual tracer mapping and omission of ALND if 3 or more SLNs were identified and all were pathologically negative. Metastatic nodes were not routinely clipped, and localization of clipped nodes was not performed. The study was performed in a single tertiary cancer center.

Intervention

Omission of ALND in patients with cN1 breast cancer after NAC if 3 or more SLNs were pathologically negative.

Main Outcome and Measures

The primary outcome was the rate of nodal recurrence among patients with cN1 breast cancer treated with SLNB alone after NAC.

Results

Of 610 patients with cN1 breast cancer treated with NAC, 555 (91%) converted to cN0 and underwent SLNB; 234 (42%) had 3 or more negative SLNs and had SLNB alone. The median (IQR) age of these 234 patients was 49 (40-58) years; median tumor size was 3 cm; 144 (62%) wereERBB2(formerlyHER2)-positive, and 43 (18%) were triple negative. Most (212 [91%]) received doxorubicin-based NAC; 205 (88%) received adjuvant radiotherapy (RT), and 164 (70%) also received nodal RT. At a median follow-up of 40 months, there was 1 axillary nodal recurrence synchronous with local recurrence in a patient who refused RT. Among patients who received RT (n = 205), there were no nodal recurrences.

Conclusions and Relevance

This cohort study found that in patients with cN1 disease rendered cN0 with NAC, with 3 or more negative SLNs with SLNB alone, nodal recurrence rates were low, without routine nodal clipping. These findings potentially support omitting ALND in such patients.
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