Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27.
OBJECTIVE
Experience with sentinel node biopsy (SNB) after neoadjuvant chemotherapy is limited. We examined the feasibility and accuracy of this procedure within a randomized trial in patients treated with neoadjuvant chemotherapy.


METHODS
During the conduct of National Surgical Adjuvant Breast and Bowel Project trial B-27, several participating surgeons attempted SNB before the required axillary dissection in 428 patients. All underwent lymphatic mapping and an attempt to identify and remove a sentinel node. Lymphatic mapping was performed with radioactive colloid (14.7%), with lymphazurin blue dye alone (29.9%), or with both (54.7%).


RESULTS
Success rate for the identification and removal of a sentinel node was 84.8%. Success rate increased significantly with the use of radioisotope (87.6% to 88.9%) versus with the use of lymphazurin alone (78.1%, P = .03). There were no significant differences in success rate according to clinical tumor size, clinical nodal status, age, or calendar year of random assignment. Of 343 patients who had SNB and axillary dissection, the sentinel nodes were positive in 125 patients and were the only positive nodes in 70 patients (56.0%). Of the 218 patients with negative sentinel nodes, nonsentinel nodes were positive in 15 (false-negative rate, 10.7%; 15 of 140 patients). There were no significant differences in false-negative rate according to clinical patient and tumor characteristics, method of lymphatic mapping, or breast tumor response to chemotherapy.


CONCLUSIONS
These results are comparable to those obtained from multicenter studies evaluating SNB before systemic therapy and suggest that the sentinel node concept is applicable following neoadjuvant chemotherapy.
Mamounas
Eleftherios P
EP
National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA. tmamounas@aultman.com
Brown
Ann
A
Anderson
Stewart
S
Smith
Roy
R
Julian
Thomas
T
Miller
Barbara
B
Bear
Harry D
HD
Caldwell
Christopher B
CB
Walker
Alonzo P
AP
Mikkelson
Wendy M
WM
Stauffer
Jay S
JS
Robidoux
Andre
A
Theoret
Heather
H
Soran
Atilla
A
Sovan
Atilla
A
Fisher
Bernard
B
Wickerham
D Lawrence
DL
Wolmark
Norman
N
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D003102:Colloids; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy; D043823:Taxoids / Q000008:administration & dosage
D003102:Colloids; D012394:Rosaniline Dyes; D043823:Taxoids; D000077143:Docetaxel; C025484:iso-sulfan blue; D004317:Doxorubicin; D003520:Cyclophosphamide