Is nodal clipping beneficial for node-positive breast cancer patients receiving neoadjuvant chemotherapy? Journal Article
| Authors: | Montagna, G.; Lee, M. K.; Sevilimedu, V.; Barrio, A. V.; Morrow, M. |
| Article Title: | Is nodal clipping beneficial for node-positive breast cancer patients receiving neoadjuvant chemotherapy? |
| Abstract: | Background: In cN1 patients rendered cN0 with neoadjuvant chemotherapy, the false-negative rate of sentinel lymph node biopsy (SLNB) is < 10% when ≥ 3 sentinel lymph nodes (SLNs) are removed. The added value of nodal clipping in this scenario is unknown. Here we determine how often the clipped node is a sentinel node when ≥ 3 SLNs are retrieved. Methods: We identified cT1-3N1 patients treated between 02/2018 and 10/2021 with a clipped lymph node at presentation. SLNB was performed with a standardized approach of dual-tracer mapping and retrieval of ≥ 3 SLNs. Clipped nodes were not localized; SLNs were X-rayed intraoperatively to determine clip location. Axillary lymph node dissection (ALND) was performed for any residual disease or retrieval of < 3 SLNs. Results: Of 269 patients, 251 (93%) had ≥ 3 SLNs. Median age was 51 years; the majority (92%) had ductal histology; 46% were HR+/HER2−. The median number of SLNs removed was 4 (IQR 3,5). The clipped node was an SLN in 88% (220/251) of cases. Of the 31 where the clipped node was not, 13 had a positive SLN mandating ALND, and the clip was identified in the ALND specimen. In the remaining 18, where ≥ 3 negative SLNs were retrieved and an ALND was not performed, the clip was not retrieved, with no axillary failures in this group (median follow-up: 55 months). Conclusion: When the SLNB procedure is optimized with dual tracer and retrieval of ≥ 3 SLNs, the clipped node is an SLN in the majority of cases, suggesting that failure to retrieve the clipped node should not be an indication for ALND. © 2022, Society of Surgical Oncology. |
| Keywords: | adult; human tissue; middle aged; cancer surgery; major clinical study; histopathology; cancer patient; neoadjuvant therapy; cancer staging; follow up; lymph node metastasis; lymph node dissection; lymph nodes; lymphatic metastasis; neoplasm staging; isosulfan blue; lymphoscintigraphy; sentinel lymph node; lymph node excision; sentinel lymph node biopsy; breast cancer; mastectomy; tumor differentiation; cohort analysis; pathology; breast neoplasms; minimal residual disease; intraoperative period; breast tumor; lymph node; mixed tumor; neoadjuvant chemotherapy; frozen section; paget nipple disease; lymphadenopathy; carcinoma, ductal, breast; axillary lymph node dissection; carcinoma, lobular; technetium sulfur colloid tc 99m; lobular carcinoma; procedures; lymph vessel metastasis; sentinel lymph node metastasis; human epidermal growth factor receptor 2 positive breast cancer; humans; human; female; article; breast ductal carcinoma; human epidermal growth factor receptor 2 negative breast cancer; hormone receptor negative breast cancer; hormone receptor-positive, her2-negative breast cancer; lymph node clipping |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 29 |
| Issue: | 10 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2022-10-01 |
| Start Page: | 6133 |
| End Page: | 6139 |
| Language: | English |
| DOI: | 10.1245/s10434-022-12240-6 |
| PUBMED: | 35902495 |
| PROVIDER: | scopus |
| PMCID: | PMC10109537 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 October 2022 -- Source: Scopus |
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