title: Axillary Staging After Neoadjuvant Chemotherapy for Breast Cancer: A Pilot Study Combining Sentinel Lymph Node Biopsy with Radioactive Seed Localization of Pre-treatment Positive Axillary Lymph Nodes.
abstract: BACKGROUND
  Neoadjuvant chemotherapy (NAC) downstages axillary disease in 55 % of node-positive (N1) breast cancer. The feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC for percutaneous biopsy-proven N1 patients who are clinically node negative (cN0) by physical examination after NAC is under investigation. ACOSOG Z1071 reported a false-negative rate of <10 % if ≥3 nodes are removed with dual tracer, including excision of the biopsy-proven positive lymph node (BxLN). We report our experience using radioactive seed localization (RSL) to retrieve the BxLN with SLNB (RSL/SLNB) for cN0 patients after NAC.
  
  
  METHODS
  We performed a retrospective review of a single-institution, prospectively maintained registry for the years 2013 to 2014. Patients with BxLN who received NAC and had RSL/SLNB were identified. All BxLNs were marked with a radiopaque clip before NAC to facilitate RSL.
  
  
  RESULTS
  Thirty patients with BxLN before NAC were cN0 after NAC and underwent RSL/SLNB. Median age was 55 years. Disease stage was IIA-IIIB. Twenty-nine of 30 had ductal cancer (12 triple negative and 16 HER-2 positive). One to 11 nodes were retrieved. Twenty-nine of 30 BxLN were successfully localized with RSL. Note was made of the BxLN-containing isotope and/or dye in 22 of 30. Nineteen patients had no residual axillary disease; 11 had persistent disease. All who remained node positive had disease in the BxLN.
  
  
  CONCLUSIONS
  RSL/SLNB is a promising approach for axillary staging after NAC in patients whose disease becomes cN0. The status of the BxLN after NAC predicted nodal status, suggesting that localization of the BxLN may be more accurate than SLNB alone for staging the axilla in the cN0 patient after NAC.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh College of Medicine, Magee Womens Hospital of UPMC, Pittsburgh, PA, USA. diegoe@upmc.edu.
authors.forename: Emilia J
authors.initials: EJ
authors.lastname: Diego
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh College of Medicine, Magee Womens Hospital of UPMC, Pittsburgh, PA, USA.
authors.forename: Priscilla F
authors.initials: PF
authors.lastname: McAuliffe
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh College of Medicine, Magee Womens Hospital of UPMC, Pittsburgh, PA, USA.
authors.forename: Atilla
authors.initials: A
authors.lastname: Soran
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Kandace P
authors.initials: KP
authors.lastname: McGuire
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh College of Medicine, Magee Womens Hospital of UPMC, Pittsburgh, PA, USA.
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Johnson
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh College of Medicine, Magee Womens Hospital of UPMC, Pittsburgh, PA, USA.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Bonaventura
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh College of Medicine, Magee Womens Hospital of UPMC, Pittsburgh, PA, USA.
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Ahrendt
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals