title: Selective sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer: results of the GEICAM 2005-07 study.
abstract: BACKGROUND
  A controversial aspect of breast cancer management is the use of sentinel lymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied.
  
  
  METHODS
  Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB.
  
  
  RESULTS
  No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P=0,002) in the negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009).
  
  
  CONCLUSIONS
  NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients.
authors.affiliation: Servicio de Cirugía General, Unidad de Mama, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: pineromadrona@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Piñero-Madrona
authors.affiliation: Departamento de Estadística, GEICAM, España.
authors.forename: María J
authors.initials: MJ
authors.lastname: Escudero-Barea
authors.affiliation: Servicio de Ginecología, Hospital Universitario de Canarias, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Robayna
authors.affiliation: Servicio de Cirugía, Unidad de Mama, Instituto Oncológico de San Sebastián, San Sebastián, España.
authors.forename: José A
authors.initials: JA
authors.lastname: Alberro-Adúriz
authors.affiliation: Servicio de Ginecología, Hospital Mutua de Terrassa, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: García-Fernández
authors.affiliation: Servicio de Cirugía General, Unidad de Mama, Hospital de Navarra, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Vicente-García
authors.affiliation: Servicio de Cirugía General, Unidad de Mama, Complejo Hospitalario, Jaén, España.
authors.forename: Basilio
authors.initials: B
authors.lastname: Dueñas-Rodriguez
authors.affiliation: Servicio de Cirugía General, Hospital Torrecárdenas, Almería, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Lorenzo-Campos
authors.affiliation: Servicio de Ginecología, Unidad de Mama, Hospital Clínico, Barcelona, España.
authors.forename: Xavier
authors.initials: X
authors.lastname: Caparrós
authors.affiliation: Servicio de Cirugía General, Unidad de Mama, Hospital General Universitario de Elche, Alicante, España.
authors.forename: María P
authors.initials: MP
authors.lastname: Cansado-Martínez
authors.affiliation: Servicio de Cirugía General, Unidad de Mama, Hospital Universitario de Salamanca, Salamanca, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramos-Boyero
authors.affiliation: Servicio de Cirugía General, Unidad de Mama, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rojo-Blanco
authors.affiliation: Servicio de Cirugía General, Unidad de Mama, Hospital General de Vic, Vic, España.
authors.forename: Constantí
authors.initials: C
authors.lastname: Serra-Genís
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Breast cancer; Cáncer de mama; Ganglio centinela; Neoadjuvant chemotherapy; Quimioterapia neoadyuvante; Sentinel lymph node