Targeted axillary biopsy and sentinel lymph node biopsy for axillary restaging after neoadjuvant chemotherapy

Gunay Gurleyik; Sibel Aydin Aksu; Fügen Aker; Kubra Kaytaz Tekyol; Eda Tanrikulu; Emin Gurleyik

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자료유형: 학술저널

저자정보: Gunay Gurleyik (Health Science University) Sibel Aydin Aksu (Health Science University) Fügen Aker (Health Science University) Kubra Kaytaz Tekyol (Health Science University) Eda Tanrikulu (Health Science University) Emin Gurleyik (Duzce University Medical Faculty)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.100 No.6

발행연도: 2021.6

수록면: 305 - 312 (8page)

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Purpose: Accurate restaging of the axilla after neoadjuvant chemotherapy (NAC) is an important issue to ensure deescalating axillary surgery in patients with initial metastatic nodes. We aimed to present our results of targeted axillary biopsy (TAB) combined with sentinel lymph node biopsy (SLNB) for axillary restaging after NAC.
Methods: In 64 breast cancer patients who underwent NAC, biopsy-proven positive nodes were marked with clips before NAC, and ultrasound-guided wire localization of clip-marked nodes was performed after NAC. Patients underwent TAB and SLNB for post-NAC axilla restaging.
Results: Identification rates of post-NAC TAB and SLNB were 98.4% and 87.5%, respectively (P = 0.033). Histopathology revealed a nodal pathologic complete response (pCR) rate of 47% in which axillary lymph node dissection (ALND) was avoided. TAB alone and SLNB alone detected residual disease in 29 (85.3%) and 20 (58.8%) patients (P = 0.029), respectively. Whereas rates of up to 97% had been achieved with a combination of TAB and SLNB. The pCR rates after NAC were 64.3% for human epidermal growth factor receptor 2 positive and triple-negative tumors and 13.6% in luminal tumors (P = 0.0002).
Conclusion: Pathologic analysis following TAB combined with SLNB revealed the pCR rates to NAC in a considerable number of patients that provided de-escalation of axillary surgery. A combination of SLNB and TAB was found to be an accurate procedure in establishing residual nodal disease. This combined procedure in patients with initially positive nodes was a reliable method for post-NAC axillary restaging.

#Breast #Lymph nodes #Neoplasms #Pathologic response #Surgery

참고문헌 (30)

참고문헌 신청

Wong SM / 2019 / Surgical management of the axilla in clinically node-positive patients receiving neoadjuvant chemo therapy: a national cancer database analysis / Ann Surg Oncol 26:3517~3525

김지영 / 2015 / Sentinel Lymph Node Biopsy Alone after Neoadjuvant Chemotherapy in Patients with Initial Cytology-Proven Axillary Node Metastasis / Journal of Breast Cancer 18(1):22~28

Simons JM / 2019 / Diagnostic accuracy of different surgical procedures for axillary staging after neoadjuvant systemic therapy in node-positive breast cancer: a systematic review and meta-analysis / Ann Surg 269:432~442

Dashevsky BZ / 2018 / Lymph node wire localization post-chemotherapy:towards improving the false negative sentinel lymph node biopsy rate in breast cancer patients / Clin Imaging 48:69~73

Diego EJ / 2016 / Axillary staging after neoadjuvant chemotherapy for breast cancer: a pilot study combining sentinel lymph node biopsy with radioactive seed localization of pre-treatment positive axillary lymph nodes / Ann Surg Oncol 23:1549~1553

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