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20.10.2018 | Clinical trial | Ausgabe 2/2019

Breast Cancer Research and Treatment 2/2019

Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study

Zeitschrift:
Breast Cancer Research and Treatment > Ausgabe 2/2019
Autoren:
Jean-Marc Classe, Cecile Loaec, P. Gimbergues, S. Alran, C. Tunon de Lara, P. F. Dupre, Roman Rouzier, C. Faure, N. Paillocher, M. P. Chauvet, G. Houvenaeghel, M. Gutowski, P. De Blay, J. L. Verhaeghe, E. Barranger, C. Lefebvre, C. Ngo, G. Ferron, C. Palpacuer, L. Campion
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10549-018-5004-7) contains supplementary material, which is available to authorized users.

Abstract

Purpose

GANEA2 study was designed to assess accuracy and safety of sentinel lymph node (SLN) after neo-adjuvant chemotherapy (NAC) in breast cancer patients.

Methods

Early breast cancer patients treated with NAC were included. Before NAC, patients with cytologically proven node involvement were allocated into the pN1 group, other patient were allocated into the cN0 group. After NAC, pN1 group patients underwent SLN and axillary lymph node dissection (ALND); cN0 group patients underwent SLN and ALND only in case of mapping failure or SLN involvement. The main endpoint was SLN false negative rate (FNR). Secondary endpoints were predictive factors for remaining positive ALND and survival of patients treated with SLN alone.

Results

From 2010 to 2014, 957 patients were included. Among the 419 patients from the cN0 group treated with SLN alone, one axillary relapse occurred during the follow-up. Among pN1 group patients, with successful mapping, 103 had a negative SLN. The FNR was 11.9% (95% CI 7.3–17.9%). Multivariate analysis showed that residual breast tumor size after NAC ≥ 5 mm and lympho-vascular invasion remained independent predictors for involved ALND. For patients with initially involved node, with negative SLN after NAC, no lympho-vascular invasion and a remaining breast tumor size 5 mm, the risk of a positive ALND is 3.7% regardless the number of SLN removed.

Conclusion

In patients with no initial node involvement, negative SLN after NAC allows to safely avoid an ALND. Residual breast tumor and lympho-vascular invasion after NAC allow identifying patients with initially involved node with a low risk of ALND involvement.

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Zusatzmaterial
Supplementary material 1 (DOCX 22 KB)
10549_2018_5004_MOESM1_ESM.docx
Literatur
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