title: Sentinel node identification rate, but not accuracy, is significantly decreased after pre-operative chemotherapy in axillary node-positive breast cancer patients.
abstract: BACKGROUND
  The aim was to prove the low identification rate of sentinel lymph node biopsy (SNB) and to determine the feasibility of replacing axillary lymph node dissection (AND) in axillary lymph node positive patients after chemotherapy.
  
  
  METHODS
  From October 2001 to July 2005, 875 consecutive patients with primary operable breast cancer underwent SNB and AND. Among them, 238 received pre-operative chemotherapy. We compared the identification rate, false negative rate (FNR), negative predictive value (NPV), and accuracy of SNB in clinically node-positive patients with or without chemotherapy.
  
  
  RESULTS
  The identification rate was significantly lower in patients received chemotherapy (77.6%) than in those not received it (97.0%) (P<0.001). In those received the therapy, the FNR was 5.6%, the NPV was 86.8%, and the accuracy was 95.9%. In those not received therapy, the FNR was 7.4% and the accuracy was 92.6% (differences not statistically significant).
  
  
  CONCLUSIONS
  The identification rate in confirmed axillary lymph node-positive patients was significantly lower in patients received pre-operative chemotherapy, but accuracy did not differ significantly between the two groups. Thus, for patients who achieve complete axillary clearance by chemotherapy, SNB could replace AND.
authors.affiliation: Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Madu-1-dong 809, Ilsan-gu Goyang-si, Gyeonggi-do, Korea.
authors.forename: Seeyoun
authors.initials: S
authors.lastname: Lee
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Seok Hyung
authors.initials: SH
authors.lastname: Kang
authors.forename: Seok Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Seok-Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: Keon Wook
authors.initials: KW
authors.lastname: Kang
authors.forename: Youngmee
authors.initials: Y
authors.lastname: Kwon
authors.forename: Kyung Hwan
authors.initials: KH
authors.lastname: Shin
authors.forename: Han-Sung
authors.initials: HS
authors.lastname: Kang
authors.forename: Jungsil
authors.initials: J
authors.lastname: Ro
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Lee
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy
chemical_list: D000970:Antineoplastic Agents