Is low-volume disease in the sentinel node after neoadjuvant chemotherapy an indication for axillary dissection? Journal Article

Authors: Moo, T. A.; Edelweiss, M.; Hajiyeva, S.; Stempel, M.; Raiss, M.; Zabor, E. C.; Barrio, A.; Morrow, M.
Article Title: Is low-volume disease in the sentinel node after neoadjuvant chemotherapy an indication for axillary dissection?
Abstract: Background/Objective: Intraoperative evaluation of sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) has a higher false-negative rate than in the primary surgical setting, particularly for small tumor deposits. Additional tumor burden seen with isolated tumor cells (ITCs) and micrometastases following primary surgery is low; however, it is unknown whether the same is true after NAC. We examined the false-negative rate of intraoperative frozen section (FS) after NAC, and the association between SLN metastasis size and residual disease at axillary lymph node dissection (ALND). Methods: Patients undergoing SLN biopsy after NAC were identified. The association between SLN metastasis size and residual axillary disease was examined. Results: From July 2008 to July 2017, 702 patients (711 cancers) had SLN biopsy after NAC. On FS, 181 had metastases, 530 were negative; 33 negative cases were positive on final pathology (false-negative rate 6.2%). Among patients with a positive FS, 3 (2%) had ITCs and no further disease on ALND; 41 (23%) had micrometastases and 125 (69%) had macrometastases. Fifty-nine percent of patients with micrometastases and 63% with macrometastases had one or more additional positive nodes at ALND. Among those with a false-negative result, 10 (30%) had ITCs, 15 (46%) had micrometastases, and 8 (24%) had macrometastases; 17 had ALND and 59% had one or more additional positive lymph nodes. Overall, 1/6 (17%) patients with ITCs and 28/44 (64%) patients with micrometastases had additional nodal metastases at ALND. Conclusion: Low-volume SLN disease after NAC is not an indicator of a low risk of additional positive axillary nodes and remains an indication for ALND, even when not detected on intraoperative FS. © 2018, Society of Surgical Oncology.
Keywords: adult; human tissue; aged; middle aged; young adult; major clinical study; cancer staging; lymph node metastasis; antineoplastic agent; lymph node dissection; sentinel lymph node biopsy; breast cancer; mastectomy; false negative result; axillary lymph node; minimal residual disease; micrometastasis; neoadjuvant chemotherapy; diagnostic test accuracy study; sentinel lymph node metastasis; estrogen receptor positive breast cancer; human epidermal growth factor receptor 2 positive breast cancer; human; article; estrogen receptor negative breast cancer; cyclophosphamide plus doxorubicin plus taxane
Journal Title: Annals of Surgical Oncology
Volume: 25
Issue: 6
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2018-06-01
Start Page: 1488
End Page: 1494
Language: English
DOI: 10.1245/s10434-018-6429-2
PROVIDER: scopus
PMCID: PMC5930130
PUBMED: 29572705
Notes: Article -- Export Date: 1 June 2018 -- Source: Scopus
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MSK Authors
  1. Andrea Veronica Barrio
    38 Barrio
  2. Monica Morrow
    450 Morrow
  3. Emily Craig Zabor
    131 Zabor
  4. Michelle Moccio Stempel
    131 Stempel
  5. Tracy-Ann Moo
    22 Moo
  6. Monica E Raiss
    4 Raiss