title: Sentinel lymph node biopsy examination for breast cancer patients with clinically negative axillary lymph nodes after neoadjuvant chemotherapy.
abstract: BACKGROUND
  The feasibility and accuracy of sentinel lymph node (SLN) biopsy examination for breast cancer patients with clinically node-negative breast cancer after neoadjuvant chemotherapy (NAC) have been investigated under the administration of a radiocolloid imaging agent injected intradermally over a tumor. In addition, conditions that may affect SLN biopsy detection and false-negative rates with respect to clinical tumor response and clinical nodal status before NAC were analyzed.
  
  
  METHODS
  Seventy-seven patients with stages II and III breast cancer previously treated with NAC were enrolled in the study. All patients were clinically node negative after NAC. The patients then underwent SLN biopsy examination, which involved a combination of intradermal injection over the tumor of radiocolloid and a subareolar injection of blue dye. This was followed by standard level I/II axillary lymph node dissection.
  
  
  RESULTS
  The SLN could be identified in 72 of 77 patients (identification rate, 93.5%). In 69 of 72 patients (95.8%) the SLN accurately predicted the axillary status. Three patients had a false-negative SLN biopsy examination result, resulting in a false-negative rate of 11.1% (3 of 27). The SLN identification rate tended to be higher, although not statistically significantly, among patients who had clinically negative axillary lymph nodes before NAC (97.6%; 41 of 42). This is in comparison with patients who had a positive axillary lymph node before NAC (88.6%; 31 of 35).
  
  
  CONCLUSIONS
  The SLN identification rate and false-negative rate were similar to those in nonneoadjuvant studies. The SLN biopsy examination accurately predicted metastatic disease in the axilla of patients with tumor response after NAC and clinical nodal status before NAC. This diagnostic technique, using an intradermal injection of radiocolloid, may provide treatment guidance for patients after NAC.
authors.affiliation: Division of Surgical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji Chuo-ku, Tokyo 104-0045, Japan. takinosh@ncc.go.jp
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Miyuki
authors.initials: M
authors.lastname: Takasugi
authors.forename: Eriko
authors.initials: E
authors.lastname: Iwamoto
authors.forename: Sadako
authors.initials: S
authors.lastname: Akashi-Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukutomi
authors.forename: Shoji
authors.initials: S
authors.lastname: Terui
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D005188:False Negative Reactions; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000166:cytology; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D021701:Sentinel Lymph Node Biopsy