title: Sentinel node biopsy prior to neoadjuvant chemotherapy.
abstract: BACKGROUND
  Several studies have explored sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy, but false negative rates and the loss of pretreatment nodal staging are limitations. Sentinel lymph node biopsy prior to induction chemotherapy may address both.
  
  
  METHODS
  Sentinel lymph node biopsy was performed in clinically node negative patients prior to initiating chemotherapy. Standard level I/II axillary lymph node dissection (ALND) was performed at the time of surgery in those patients who had metastases in the sentinel lymph node (SLN).
  
  
  RESULTS
  Twenty-five patients had 26 SLNB prior to the initiation of chemotherapy. The SLN was identified in all cases (100%). Twelve patients (48%) were found to be node negative and did not require axillary node dissection after chemotherapy. Of the patients who were SLN positive and underwent completion ALND, residual nodal disease was identified in 60%. There were no surgical complications or delay of chemotherapy.
  
  
  CONCLUSIONS
  Sentinel lymph node biopsy prior to neoadjuvant chemotherapy can avoid the morbidity of ALND without compromising the accuracy of axillary staging. It allows for identification of node positive patients subsequently rendered disease free in the regional nodes, which can assist in planning additional chemotherapy or radiation.
authors.affiliation: Breast Oncology Program and Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA. msabel@umich.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sabel
authors.forename: Anne F
authors.initials: AF
authors.lastname: Schott
authors.forename: Celina G
authors.initials: CG
authors.lastname: Kleer
authors.forename: Sofia
authors.initials: S
authors.lastname: Merajver
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Cimmino
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Diehl
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hayes
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Chang
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Pierce
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy