Is residual nodal disease at axillary dissection associated with tumor subtype in patients with low volume sentinel node metastasis after neoadjuvant chemotherapy? Journal Article

   

Authors:	Moo, T. A.; Pawloski, K. R.; Flynn, J.; Edelweiss, M.; Le, T.; Tadros, A.; Barrio, A. V.; Morrow, M.
Article Title:	Is residual nodal disease at axillary dissection associated with tumor subtype in patients with low volume sentinel node metastasis after neoadjuvant chemotherapy?
Abstract:	Background: In patients with a positive sentinel lymph node (SLN) after neoadjuvant chemotherapy (NAC), the likelihood of residual nodal disease at axillary dissection (ALND) is high. Whether non-SLN metastasis frequency varies based on tumor subtype and SLN metastasis size is uncertain. We examined the association between tumor subtype and frequency of non-SLN metastases in patients with SLN micro- vs macrometastases after NAC. Methods: Patients with invasive breast cancer and a positive SLN biopsy after NAC between July 2008 and July 2019 were identified. Associations between tumor subtype, SLN disease volume, and frequency of non-SLN metastases were examined. Results: Among 273 patients with ≥ 1 positive SLN and a completion ALND, mean age was 51 years, 87% of tumors were ductal, 80% were clinically node-positive at presentation, and 85% were cT2-3. The frequency of non-SLN metastases was non-significantly higher in HR+/HER2- (61%) vs. HER2+ (52%) and triple negative tumors (45%) (p = 0.09). Frequency of SLN micrometastasis was 9% for triple negative tumors compared with 17% for HR+/HER2- and 34% for HER2+ tumors (p = 0.015). Size of SLN metastasis (micro- vs. macrometastases) was not associated with non-SLN metastasis frequency or number within any subtype. Conclusions: In patients with a positive SLN after NAC, the likelihood of non-SLN metastasis at ALND was high across all tumor subtypes and did not vary significantly for SLN micro- versus macrometastases. ALND is recommended for SLN micro- and macrometastases after NAC, irrespective of tumor subtype. © 2021, Society of Surgical Oncology.
Keywords:	adult; cancer chemotherapy; controlled study; human tissue; middle aged; major clinical study; adjuvant therapy; neoadjuvant therapy; lymph node metastasis; antineoplastic agent; lymphatic metastasis; sentinel lymph node; sentinel lymph node biopsy; disease association; metastasis; morbidity; dissection; retrospective study; minimal residual disease; micrometastasis; surgery; neoadjuvant chemotherapy; axilla; lymph node biopsy; axillary lymph node dissection; triple negative breast cancer; macrometastasis; lymph vessel metastasis; sentinel lymph node metastasis; human epidermal growth factor receptor 2 positive breast cancer; humans; human; female; article; human epidermal growth factor receptor 2 negative breast cancer
Journal Title:	Annals of Surgical Oncology
Volume:	28
Issue:	11
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2021-10-01
Start Page:	6044
End Page:	6050
Language:	English
DOI:	10.1245/s10434-021-09910-2
PUBMED:	33876362
PROVIDER:	scopus
PMCID:	PMC10224770
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85115451310&doi=10.1245%2fs10434-021-09910-2&partnerID=40&md5=427e33509103ddb232a5430cc3be5d75
Notes:	Article -- Source: Scopus

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