title: Sentinel lymph node biopsy in patients with operable breast cancer treated with neoadjuvant chemotherapy.
abstract: OBJECTIVE
  To evaluate the accuracy of sentinel lymph node biopsy (SLNB) in operable breast cancer patients treated with neoadjuvant chemotherapy (NAC).
  
  
  METHODS
  Between January 2008-2011, 88 women, mean age 49.4 years, with infiltrating breast carcinoma, were studied prospectively. Patients were T1-3, N0-1, M0. Prior to surgery, the patients received chemotherapy (epirubicin/cyclophosphamide, docetaxel), and trastuzumab in Her2/neu-positive patients. Axillary status was established by physical examination, ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB, followed by complete axillary lymph node dissection (ALND). Sentinel lymph node (SLN) were examined by frozen sections, hematoxylin-eosin staining and immunohistochemical analysis or One Step Nucleic Acid Amplification (OSNA).
  
  
  RESULTS
  Mean tumor size: 3.5 cm. Histologic type: 69 invasive ductal, 16 invasive lobular and 3 others. Thirty seven patients had clinical/ultrasound node-positive at presentation. Clinical response of primary tumor to NAC: complete in 38, partial in 45, and stable disease in 5 patients. A pathological complete response was achieved in 25. All patients were clinically node-negative after NAC. SLN identification rate was 92.0%. Six of 7 patients in whom SLN was not found had clinical/ultrasound positive axilla before NAC. SLN accurately determined the axillary status in 96.5%. False negative rate was 8.3%. In 69.4% of patients, SLN was the only positive node. The mean number of SLN removed was 1.7 and nodes resected from the ALND were 13.2.
  
  
  CONCLUSIONS
  SLN biopsy after NAC can predict the axillary status with a high accuracy in patients with breast cancer, avoiding unnecessary ALND.
authors.affiliation: Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: A C
authors.initials: AC
authors.lastname: Rebollo-Aguirre
authors.forename: M
authors.initials: M
authors.lastname: Gallego-Peinado
authors.forename: S
authors.initials: S
authors.lastname: Menjón-Beltrán
authors.forename: J
authors.initials: J
authors.lastname: García-García
authors.forename: E
authors.initials: E
authors.lastname: Pastor-Pons
authors.forename: C E
authors.initials: CE
authors.lastname: Chamorro-Santos
authors.forename: C
authors.initials: C
authors.lastname: Ramos-Font
authors.forename: A
authors.initials: A
authors.lastname: Salamanca-Ballesteros
authors.forename: J M
authors.initials: JM
authors.lastname: Llamas-Elvira
authors.forename: N
authors.initials: N
authors.lastname: Olea-Serrano
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001365:Axilla; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D043823:Taxoids / Q000008:administration & dosage; D013668:Technetium Tc 99m Aggregated Albumin; D000068878:Trastuzumab; D018084:Ultrasonography, Interventional
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D019275:Radiopharmaceuticals; D043823:Taxoids; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid; D000077143:Docetaxel; D015251:Epirubicin; D003520:Cyclophosphamide; D000068878:Trastuzumab