title: Sentinel lymph node biopsy alone after neoadjuvant chemotherapy in patients with initial cytology-proven axillary node metastasis.
abstract: OBJECTIVE
  Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis.
  
  
  METHODS
  From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results.
  
  
  RESULTS
  At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050).
  
  
  CONCLUSIONS
  SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection.
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: MD Hospital, Seoul, Korea.
authors.forename: Min Kuk
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jeong Eon
authors.initials: JE
authors.lastname: Lee
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Yongsik
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Soo Youn
authors.initials: SY
authors.lastname: Bae
authors.affiliation: Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Se Kyung
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kil
authors.affiliation: Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seok Won
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Ulsan City Hospital, Ulsan, Korea.
authors.forename: Ku Sang
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Nam
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Sehwan
authors.initials: S
authors.lastname: Han
keywords: Axilla; Breast neoplasms; Neoadjuvant therapy; Neoplasm metastasis; Sentinel lymph node biopsy
references.citation: JAMA. 2013 Oct 9;310(14):1455-61
references.pmid: 24101169
references.citation: J Clin Oncol. 2004 Jun 15;22(12):2303-12
references.pmid: 15197191
references.citation: Cancer. 2000 Dec 1;89(11):2187-94
references.pmid: 11147588
references.citation: Br J Surg. 2006 May;93(5):539-46
references.pmid: 16329089
references.citation: J Clin Oncol. 2002 Mar 1;20(5):1304-10
references.pmid: 11870173
references.citation: J Breast Cancer. 2012 Jun;15(2):203-10
references.pmid: 22807938
references.citation: Cancer. 2010 Mar 15;116(6):1431-9
references.pmid: 20131351
references.citation: Ann Surg Oncol. 2006 Nov;13(11):1434-42
references.pmid: 16983592
references.citation: Ann Surg Oncol. 2008 May;15(5):1316-21
references.pmid: 18311507
references.citation: Eur J Cancer. 2009 Sep;45(13):2284-92
references.pmid: 19464164
references.citation: Ann Oncol. 2005 Jan;16(1):56-63
references.pmid: 15598939
references.citation: Ann Surg. 1999 Jul;230(1):72-8
references.pmid: 10400039
references.citation: N Engl J Med. 2002 Aug 22;347(8):567-75
references.pmid: 12192016
references.citation: J Clin Oncol. 2009 Jun 20;27(18):2946-53
references.pmid: 19364968
references.citation: Cancer. 2011 Oct 15;117(20):4606-16
references.pmid: 21437896
references.citation: Br J Surg. 2005 Jan;92(1):14-23
references.pmid: 15635596
references.citation: Surg Clin North Am. 2003 Aug;83(4):931-42
references.pmid: 12875603
references.citation: J Clin Oncol. 1997 Jul;15(7):2483-93
references.pmid: 9215816
references.citation: J Natl Cancer Inst. 2008 Apr 16;100(8):552-62
references.pmid: 18398094
references.citation: J Clin Oncol. 2012 May 20;30(15):1796-804
references.pmid: 22508812
references.citation: Cancer. 2000 Mar 15;88(6):1417-24
references.pmid: 10717625
references.citation: J Clin Oncol. 2005 Apr 20;23(12):2694-702
references.pmid: 15837984
references.citation: J Clin Oncol. 2005 Oct 20;23 (30):7703-20
references.pmid: 16157938
references.citation: N Engl J Med. 2003 Aug 7;349(6):546-53
references.pmid: 12904519
references.citation: Clin Cancer Res. 2005 Aug 15;11(16):5678-85
references.pmid: 16115903
references.citation: Ann Surg Oncol. 1998 Dec;5(8):673-80
references.pmid: 9869512