Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: Results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27

PurposeExperience with sentinel node biopsy (SNB) after neoadjuvant chemotherapy is limited. We examined the feasibility and accuracy of this procedure within a randomized trial in patients treated with neoadjuvant chemotherapy.Patients and MethodsDuring the conduct of National Surgical Adjuvant Breast and Bowel Project trial B-27, several participating surgeons attempted SNB before the required axillary dissection in 428 patients. All underwent lymphatic mapping and an attempt to identify and remove a sentinel node. Lymphatic mapping was performed with radioactive colloid (14.7%), with lymphazurin blue dye alone (29.9%), or with both (54.7%).ResultsSuccess rate for the identification and removal of a sentinel node was 84.8%. Success rate increased significantly with the use of radioisotope (87.6% to 88.9%) versus with the use of lymphazurin alone (78.1%, P = .03). There were no significant differences in success rate according to clinical tumor size, clinical nodal status, age, or calendar year of random assignment. Of 343 patients who had SNB and axillary dissection, the sentinel nodes were positive in 125 patients and were the only positive nodes in 70 patients (56.0%). Of the 218 patients with negative sentinel nodes, nonsentinel nodes were positive in 15 (false-negative rate, 10.7%; 15 of 140 patients). There were no significant differences in false-negative rate according to clinical patient and tumor characteristics, method of lymphatic mapping, or breast tumor response to chemotherapy.ConclusionThese results are comparable to those obtained from multicenter studies evaluating SNB before systemic therapy and suggest that the sentinel node concept is applicable following neoadjuvant chemotherapy.

目的 新辅助化疗后前哨淋巴结活检（SNB）的经验有限。我们在一项针对接受新辅助化疗患者的随机试验中检验了该操作的可行性和准确性。 患者与方法 在国家外科辅助乳腺和肠道项目B - 27试验过程中，若干参与的外科医生在428例患者所需的腋窝清扫之前尝试进行SNB。所有患者都接受了淋巴绘图，并尝试识别和切除前哨淋巴结。淋巴绘图采用放射性胶体（14.7%）、单独使用异硫蓝染料（29.9%）或两者联合（54.7%）的方法进行。 结果 识别和切除前哨淋巴结的成功率为84.8%。与单独使用异硫蓝相比，使用放射性同位素时成功率显著提高（87.6% - 88.9%对78.1%，P = 0.03）。根据临床肿瘤大小、临床淋巴结状态、年龄或随机分组的年份，成功率没有显著差异。在343例同时进行了SNB和腋窝清扫的患者中，125例患者的前哨淋巴结为阳性，其中70例患者（56.0%）仅有前哨淋巴结阳性。在218例前哨淋巴结阴性的患者中，非前哨淋巴结阳性的有15例（假阴性率为10.7%；140例患者中有15例）。根据临床患者和肿瘤特征、淋巴绘图方法或乳腺肿瘤对化疗的反应，假阴性率没有显著差异。 结论 这些结果与在系统治疗前评估SNB的多中心研究结果相当，表明前哨淋巴结的概念适用于新辅助化疗之后。