title: Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study.
abstract: OBJECTIVE
  An increasing proportion of patients (> 30%) with node-positive breast cancer will obtain an axillary pathologic complete response after neoadjuvant chemotherapy (NAC). If sentinel node (SN) biopsy (SNB) is accurate in this setting, completion node dissection (CND) morbidity could be avoided.
  
  
  METHODS
  In the prospective multicentric SN FNAC study, patients with biopsy-proven node-positive breast cancer (T0-3, N1-2) underwent both SNB and CND. Immunohistochemistry (IHC) use was mandatory, and SN metastases of any size, including isolated tumor cells (ypN0[i+], ≤ 0.2 mm), were considered positive. The optimal SNB identification rate (IR) ≥ 90% and false-negative rate (FNR) ≤ 10% were predetermined.
  
  
  RESULTS
  From March 2009 to December 2012, 153 patients were accrued to the study. The SNB IR was 87.6% (127 of 145; 95% CI, 82.2% to 93.0%), and the FNR was 8.4% (seven of 83; 95% CI, 2.4% to 14.4%). If SN ypN0(i+)s had been considered negative, the FNR would have increased to 13.3% (11 of 83; 95% CI, 6.0% to 20.6%). There was no correlation between size of SN metastases and rate of positive non-SNs. Using this method, 30.3% of patients could potentially avoid CND.
  
  
  CONCLUSIONS
  In biopsy-proven node-positive breast cancer after NAC, a low SNB FNR (8.4%) can be achieved with mandatory use of IHC. SN metastases of any size should be considered positive. The SNB IR was 87.6%, and in the presence of a technical failure, axillary node dissection should be performed. We recommend that SN evaluation with IHC be further evaluated before being included in future guidelines on the use of SNB after NAC in this setting.
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA. jean-francois.boileau@mcgill.ca.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Boileau
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Poirier
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Mark
authors.initials: M
authors.lastname: Basik
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Claire M B
authors.initials: CM
authors.lastname: Holloway
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Louis
authors.initials: L
authors.lastname: Gaboury
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Sideris
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Meterissian
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Angel
authors.initials: A
authors.lastname: Arnaout
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Muriel
authors.initials: M
authors.lastname: Brackstone
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: David R
authors.initials: DR
authors.lastname: McCready
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Karp
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Trop
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Andre
authors.initials: A
authors.lastname: Lisbona
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Frances C
authors.initials: FC
authors.lastname: Wright
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Rami J
authors.initials: RJ
authors.lastname: Younan
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Louise
authors.initials: L
authors.lastname: Provencher
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Erica
authors.initials: E
authors.lastname: Patocskai
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Atilla
authors.initials: A
authors.lastname: Omeroglu
authors.affiliation: Jean-Francois Boileau, Mark Basik, and Andre Lisbona, Montreal Jewish General Segal Cancer Centre, McGill University; Louis Gaboury, Isabelle Trop, Rami J. Younan, Erica Patocskai, and Andre Robidoux, Centre Hospitalier de l'Universite de Montreal; Lucas Sideris, Hopital Maisonneuve Rosemont, Universite de Montreal; Sarkis Meterissian and Atilla Omeroglu, McGill University Health Centre, Montreal; Brigitte Poirier and Louise Provencher, Hopital Saint-Sacrement, Universite Laval, Quebec City, Quebec; Claire M.B. Holloway and Frances C. Wright, Sunnybrook Odette Cancer Centre, University of Toronto; David R. McCready, University Health Network, University of Toronto, Toronto; Angel Arnaout, Ottawa Hospital, University of Ottawa, Ottawa; Muriel Brackstone, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; and Stephen E. Karp, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Andre
authors.initials: A
authors.lastname: Robidoux
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy