Erschienen in:
24.04.2019 | Breast Oncology
Sentinel Node Biopsy After Neoadjuvant Systemic Therapy for Breast Cancer: The Method Matters
verfasst von:
Harry D. Bear, MD, PhD, Kandace P. McGuire, MD
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 8/2019
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Excerpt
The transition from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB) has been a major advance over the past 30 years, leading to decreased morbidity of breast cancer treatment.
1,
2 Similarly, demonstrations that neoadjuvant systemic therapy (NST) is equivalent to adjuvant therapy have paved the way to de-escalation of local and regional therapies, despite some concerns about possible increased risk of local recurrence in the breast.
3–8 For example, now NST often is used to avoid total mastectomy, to reduce the magnitude of partial mastectomies and potentially to avoid ALND and/or regional nodal irradiation, even in patients with clinically positive nodes at the time of diagnosis.
6,
9,
10 The use of SLNB in place of ALND after NST has been widely accepted for patients with clinically negative nodes at presentation, but the same approach has been more controversial for patients with clinically and pathologically proven positive nodes. Current NCCN guidelines regarding surgical lymph node staging after NST state that if axillary node imaging or needle biopsy is negative, then SLN should preferably be performed after NST.
11 It also notes that NST “may allow SLNB alone if a positive axilla is cleared with therapy.” ASCO guidelines from 2016 suggest that SLNB may be offered to patients who receive NST but suggest caution for patients with large or bulky metastatic axillary nodes.
12 Conversion of positive to negative nodes is more likely to occur with triple negative or HER-2
+ breast cancers, and multiple studies have shown that neoadjuvant chemotherapy results in a fairly consistent conversion rate from clinically positive nodes to pathologically negative nodes in the range of 40%.
10,
13–17 …