title: Accuracy of sentinel lymph node biopsy after neo-adjuvant chemotherapy in patients with locally advanced breast cancer and clinically positive axillary nodes.
abstract: BACKGROUND
  Feasibility and accuracy of sentinel node biopsy (SLNB) after the delivery of neo-adjuvant chemotherapy (NAC) is controversial. We here report our experience in NAC-treated patients with locally advanced breast cancer and clinically positive axillary nodes, and compare it with the results from our previous randomized trial assessing SLNB in early-stage breast cancer patients.
  
  
  METHODS
  Sixty-four consecutive patients with large infiltrating tumor and clinically positive axillary nodes received NAC and subsequent lymphatic mapping, SLNB and complete axillary lymph node dissection (ALND). The status of the sentinel lymph node (SLN) was compared to that of the axilla.
  
  
  RESULTS
  At least one SLN was identified in 60 of the 64 patients (93.8%). Among those 60 patients, 37 (61.7%) had one or more positive SLN(s) and 23 (38.3%) did not. Two of the patients with negative SLN(s) presented metastases in other non-sentinel nodes. SLNB thus had a false-negative rate, a negative predictive value and an overall accuracy of 5.1%, 91.3% and 96.7%, respectively. All these values were similar to those we reported for SLNB in the settings of early-stage breast cancer.
  
  
  CONCLUSIONS
  SLNB after NAC is safe and feasible in patients with locally advanced breast cancer and clinically positive nodes, and accurately predicts the status of the axilla.
authors.affiliation: Surgical Senology Unit, National Cancer Research Institute, Genova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Canavese
authors.forename: B
authors.initials: B
authors.lastname: Dozin
authors.forename: C
authors.initials: C
authors.lastname: Vecchio
authors.forename: D
authors.initials: D
authors.lastname: Tomei
authors.forename: G
authors.initials: G
authors.lastname: Villa
authors.forename: F
authors.initials: F
authors.lastname: Carli
authors.forename: L
authors.initials: L
authors.lastname: Del Mastro
authors.forename: A
authors.initials: A
authors.lastname: Levaggi
authors.forename: C
authors.initials: C
authors.lastname: Rossello
authors.forename: S
authors.initials: S
authors.lastname: Spinaci
authors.forename: P
authors.initials: P
authors.lastname: Bruzzi
authors.forename: A
authors.initials: A
authors.lastname: Catturich
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011237:Predictive Value of Tests; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*