title: Sentinel lymph node biopsy after neoadjuvant chemotherapy predicts pathological axillary lymph node status in breast cancer patients with clinically positive axillary lymph nodes at presentation.
abstract: BACKGROUND
  It is still controversial whether axillary lymph node (ALN) dissection (ALND) can be omitted after negative sentinel lymph node (SLN) biopsy (SLNB) in breast cancer (BC) patients with clinically positive ALNs at presentation treated with neoadjuvant chemotherapy (NAC). The study aim was to analyze whether SLNB could be useful in these patients.
  
  
  METHODS
  In a retrospective study, eligible patients were women with invasive BC with clinically positive ALNs at presentation, treated with NAC then a total or partial mastectomy, with an intraoperative histological examination of SLNs and non-SLNs suspicious for metastasis followed by ALND. Non-SLNs suspicious for metastasis were defined as hard or large nodes located in the same level of the axilla where clinically positive ALNs had been initially identified. The results of SLNB and clinicopathological characteristics were analyzed for correlation with pathological ALN status.
  
  
  RESULTS
  In a consecutive series of 105 women with 107 BC cases, 81 (75.7 %) had at least 1 SLN, and the remaining 26 (24.3 %) had at least 1 non-SLN suspicious for metastasis. The intraoperative (or final) histological examination of these nodes revealed that the false-negative (FN) rate and accuracy were 8.2 (or 6.3) % and 95.1 (or 96.3) %, respectively. Estrogen receptor status at presentation, pathological tumor response, lymphovascular invasion after NAC, and NAC regimen were correlated with pathological ALN status.
  
  
  CONCLUSIONS
  The histological examination of SLNs and that of non-SLNs suspicious for metastasis are useful for predicting pathological ALN status in BC patients with clinically positive ALNs at presentation who are treated with NAC.
authors.affiliation: Division of Breast Surgery, Saitama Cancer Center, 818 Komuro Ina, Kita-Adachi, Saitama, 362-0806, Japan. qyq05440@nifty.com
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takei
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kurosumi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Toru
authors.initials: T
authors.lastname: Higuchi
authors.forename: Sayaka
authors.initials: S
authors.lastname: Uchida
authors.forename: Jun
authors.initials: J
authors.lastname: Ninomiya
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kubo
authors.forename: Hanako
authors.initials: H
authors.lastname: Oba
authors.forename: Shigenori
authors.initials: S
authors.lastname: Nagai
authors.forename: Toshio
authors.initials: T
authors.lastname: Tabei
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy