Intraoperative sentinel lymph node evaluation in patients with node-positive breast cancer status post neoadjuvant systemic therapy - An institutional experience |
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Institution: | 1. Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America;2. Department of Surgery, University of Kansas Medical Center, Kansas City, KS, United States of America;1. Brigham and Women''s Hospital, Harvard University, New Research Building Room 652 (Stowell Lab), 77 Avenue Louis Pasteur, Boston, MA 02115, United States of America;2. Biconcavity Inc., 1106 Spring Mill Dr. SW, Lilburn, GA 30047, United States of America;3. University of Rochester Medical Center, Department of Pathology and Laboratory Medicine, 211 Bailey Road, West Henrietta, NY 14586, United States of America;1. Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan;2. Genome Analysis Center, Yamanashi Central Hospital, 1-1-1 Fujimi, Kofu City, Yamanashi 400-8506, Japan;3. Department of Gastroenterology, Yamanashi Central Hospital, 1-1-1 Fujimi, Kofu City, Yamanashi 400-8506, Japan;4. Department of Pathology, Yamanashi Central Hospital, 1-1-1 Fujimi, Kofu City, Yamanashi 400-8506, Japan;5. Department of Surgery, Yamanashi Central Hospital, 1-1-1 Fujimi, Kofu City, Yamanashi 400-8506, Japan;6. University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;1. Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing 100730, China;2. Department of Pathology, Beijing Chuiyangliu Hospital, Beijing 100022, China;1. Department of Pathology and Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China;2. Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China;3. Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100069, China;4. Department of Pathology and Key Laboratory for Xinjiang Endemic & Ethnic Diseases, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, 832002, China;5. Department of Pathology, Shanghai PuDong GongLi Hospital, Shanghai, 200135, China |
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Abstract: | Recent studies have shown the feasibility and utility of sentinel lymph node (SLN) biopsy in patients with biopsy proven node-positive breast cancer after neoadjuvant chemotherapy. We reviewed our experience in intraoperative SLN evaluation in such cases and its effect on axillary management. A retrospective analysis of breast cancer patients (2015–2018) with a biopsy-proven positive axillary lymph node, who received neoadjuvant systemic therapy and underwent intraoperative SLN assessment was performed. Intraoperative SLN assessment results were compared with final pathology. Its accuracy and effect on axillary management is summarized. We identified 106 patients with positive axillary lymph node and neoadjuvant systemic therapy between the ages of 28 and 75 years who had SLN biopsy and lumpectomy (33) or mastectomy (73). Three or more SLNs were identified in 91 cases (86 %). The previously biopsied lymph node was identified as one of the sentinel lymph nodes in 93 cases (88 %). There is a high concordance rate between frozen section diagnosis and final diagnosis on sentinel lymph nodes. No false positive case and seven false negative frozen section diagnosis cases (diagnosed as negative on frozen section and positive on permanent sections) were identified. False-negative frozen section diagnosis correlated with low-volume nodal disease and obscuring tumor bed changes. Almost half of the positive lymph nodes were converted to negative after neoadjuvant chemotherapy. SLN biopsy with intraoperative frozen section evaluation after neoadjuvant systemic therapy in node-positive patients is an effective way to minimize axillary surgery. |
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