False Negative Rate of Sentinel Lymph Node Biopsy (SLNB) in Breast Cancer Patients after Neoadjuvant Chemotherapy False negative rate after SLNB

Ramesh Omranipour (1), Seyed Mohammad Mehdi Ghaffari Hamedani (2), Sadaf Alipour (3), Shiller Hesamiazar (4), Bita Eslami (5)
(1) Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran/Department of Surgical Oncology, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of,
(2) Department of Surgery, Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran, Iran, Islamic Republic of,
(3) Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran/Department of Surgery, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of,
(4) Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of,
(5) Breast Cancer Research Center, Tehran University of Medical Sciences, Iran, Islamic Republic of

Abstract

Background: Managing the axilla in patients with node-positive breast cancer who converted to node-negative patients after neoadjuvant chemotherapy is a challenging issue. We aim to analyze the false negative rate (FNR) of SLNB after neoadjuvant chemotherapy in this group of patients.


Methods: In this cross-sectional study, we reviewed the results of SLNB and ALND in 368 breast cancer patients who underwent neoadjuvant chemotherapy from 2015 to 2019. The study included patients with pathologically proven axillary lymph nodes undergoing NAC. We collected the data from the Breast Diseases Research Center of Tehran University of Medical Sciences.


Results: The average age of the patients was 46.58±10.91. Of all the patients, 205 (55.7%) had positive SLN in the histologic analysis after surgery, while 163 (44.3%) had negative results. The study also revealed that the FNR of SLNB was 9.8% (n=16). Our results showed that SLN had 86.55% sensitivity and 100% specificity in detecting involved nodes. Furthermore, after multivariable analysis, we observed that a higher number of ALND dissections were associated with a higher FNR (Odds ratio; OR=1.20, 95% CI: 1.02-1.42); while a higher number of SLN excisions was linked with a lower FNR (OR=0.41; 95% CI: 0.17-0.98).


Conclusion: After NAC in breast cancer patients with positive lymph nodes, SLNB is feasible with a low FNR; the latter is correlated with the number of nodes removed during the procedure.

Full text article

Generated from XML file

References

Lyman GH, Temin S, Edge SB, Newman LA, Turner RR, Weaver DL, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365-83. doi: 10.1200/JCO.2013.54.1177.

Pesek S, Ashikaga T, Krag LE, Krag D. The false-negative rate of sentinel node biopsy in patients with breast cancer: a meta-analysis. World J Surg. 2012;36:2239-51. doi: 10.1007/s00268-012-1623-z.

Martin RC, Chagpar A, Scoggins CR, Edwards MJ, Hagendoorn L, Stromberg AJ, et al. Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg. 2005 Jun 1;241(6):1005-15. doi: 10.1097/01.sla.0000165200.32722.02.

Shen J, Gilcrease MZ, Babiera GV, Ross MI, Meric‐Bernstam F, Feig BW, et al. Feasibility and accuracy of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients with documented axillary metastases. Cancer. 2007 Apr;109(7):1255-63. doi: 10.1002/cncr.22540.

Cohen LF, Breslin TM, Kuerer HM, Ross MI, Hunt KK, Sahin AA. Identification and evaluation of axillary sentinel lymph nodes in patients with breast carcinoma treated with neoadjuvant chemotherapy. Am J Surg Pathol. 2000;24(9):1266-72. doi: 10.1097/00000478-200009000-00010.

Lee S, Kim EY, Kang SH, Kim SW, Kim SK, Kang KW, et al. Sentinel node identification rate, but not accuracy, is significantly decreased after pre-operative chemotherapy in axillary node-positive breast cancer patients. Breast Cancer Res Treat. 2007;102:283-8. doi: 10.1007/s10549-006-9330-9

Brown AS, Hunt KK, Shen J, Huo L, Babiera GV, Ross MI, et al. Histologic changes associated with false‐negative sentinel lymph nodes after preoperative chemotherapy in patients with confirmed lymph node‐positive breast cancer before treatment. Cancer. 2010;116(12):2878-83. doi: 10.1002/cncr.25066

Newman EA, Sabel MS, Nees AV, Schott A, Diehl KM, Cimmino VM, et al. Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation. Ann Surg Oncol. 2007;14:2946-52. doi: 10.1245/s10434-007-9403-y.

Classe JM, Bordes V, Campion L, Mignotte H, Dravet F, Leveque J, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer: results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study. J Clin Oncol. 2009;27(5):726-32. doi: 10.1200/JCO.2008.18.3228.

Mamounas EP, Brown A, Anderson S, Smith R, Julian T, Miller B, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2005;23(12):2694-2702. doi: 10.1200/JCO.2005.05.188.

Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncology. 2013 Jun 1;14(7):609-18. doi: 10.1016/S1470-2045(13)70136-0.

Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-61. doi:10.1001/jama.2013.278932.

Boileau JF, Poirier B, Basik M, Holloway CM, Gaboury L, Sideris L, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol. 2015;33(3):258-64. doi: 10.1200/JCO.2014.55.7827.

Van Nijnatten TJ, Schipper RJ, Lobbes MB, Nelemans PJ, Beets-Tan RG, Smidt ML. The diagnostic performance of sentinel lymph node biopsy in pathologically confirmed node positive breast cancer patients after neoadjuvant systemic therapy: a systematic review and meta-analysis. Eur J Surg Oncol. 2015;41(10):1278-87. doi: 10.1016/j.ejso.2015.07.020.

Tee SR, Devane LA, Evoy D, Rothwell J, Geraghty J, Prichard RS, et al. Meta-analysis of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer. J Br Surg. 2018;105(12):1541-52. doi: 10.1002/bjs.10986.

Aragon-Sanchez S, Oliver-Perez MR, Madariaga A, Tabuenca MJ, Martinez M, Galindo A, et al. Accuracy and limitations of sentinel lymph node biopsy after Neoadjuvant Chemotherapy in breast cancer patients with positive nodes. Breast J. 2022 Aug 5;2022. doi: 10.1155/2022/1507881.

Lazar AM, Mutuleanu MD, Spiridon PM, Bordea CI, Suta TL, Blidaru A, Gherghe M. Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Axillary Conversion after Neoadjuvant Chemotherapy—A Single-Tertiary Centre Experience and Review of the Literature. Diagnostics. 2023;13(18):3000. doi: 10.3390/diagnostics13183000.

Ozmen V, Cabioglu N. Sentinel lymph node biopsy for breast cancer: current controversies. Breast J. 2006 Sep;12:S134-42. doi: 10.1111/j.1075-122X.2006.00327.x.

Alvarado R, Yi M, Le-Petross H, Gilcrease M, Mittendorf EA, Bedrosian I, et al. The role for sentinel lymph node dissection after neoadjuvant chemotherapy in patients who present with node-positive breast cancer. Ann Surg Oncol. 2012;19:3177-84. doi: 10.1245/s10434-012-2484-2.

Authors

Ramesh Omranipour
Seyed Mohammad Mehdi Ghaffari Hamedani
Sadaf Alipour
Shiller Hesamiazar
Bita Eslami
dr.bes.96@gmail.com (Primary Contact)
1.
Omranipour R, Ghaffari Hamedani SMM, Alipour S, Hesamiazar S, Eslami B. False Negative Rate of Sentinel Lymph Node Biopsy (SLNB) in Breast Cancer Patients after Neoadjuvant Chemotherapy: False negative rate after SLNB. Arch Breast Cancer [Internet]. 2024 Jul. 31 [cited 2024 Dec. 10];11(3). Available from: https://www.archbreastcancer.com/index.php/abc/article/view/959

Article Details

Most read articles by the same author(s)

1 2 3 > >>