title: Validation of sentinel lymph node biopsy in breast cancer women N1-N2 with complete axillary response after neoadjuvant chemotherapy. Multicentre study in Tarragona.
abstract: BACKGROUND
  The aim of our study was to evaluate sentinel lymph node biopsy as a diagnostic test for assessing the presence of residual metastatic axillary lymph nodes after neoadjuvant chemotherapy, replacing the need for a lymphadenectomy in negative selective lymph node biopsy patients.
  
  
  METHODS
  A multicentre, diagnostic validation study was conducted in the province of Tarragona, on women with T1-T3, N1-N2 breast cancer, who presented with a complete axillary response after neoadjuvant chemotherapy. Study procedures consisted of performing an selective lymph node biopsy followed by lymphadenectomy.
  
  
  RESULTS
  A total of 53 women were included in the study. Surgical detection rate was 90.5% (no sentinel node found in 5 patients). Histopathological analysis of the lymphadenectomy showed complete disease regression of axillary nodes in 35.4% (17/48) of the patients, and residual axillary node involvement in 64.6% (31/48) of them. In lymphadenectomy positive patients, 28 had a positive selective lymph node biopsy (true positive), while 3 had a negative selective lymph node biopsy (false negative). Of the 28 true selective lymph node biopsy positives, the sentinel node was the only positive node in 10 cases. All lymphadenectomy negative cases were selective lymph node biopsy negative. These data yield a sensitivity of 93.5%, a false negative rate of 9.7%, and a global test efficiency of 93.7%.
  
  
  CONCLUSIONS
  Selective lymph node biopsy after chemotherapy in patients with a complete axillary response provides valid and reliable information regarding axillary status after neoadjuvant treatment, and might prevent lymphadenectomy in cases with negative selective lymph node biopsy.
authors: Servicio de Medicina Nuclear, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España.
authors: D
authors: D
authors: Carrera
authors: Servicio de Ginecología y Obstetricia, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España. Electronic address: miriamjose.delaflor@urv.cat.
authors: M
authors: M
authors: de la Flor
authors: Servicio de Ginecología y Obstetricia, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España.
authors: J
authors: J
authors: Galera
authors: Servicio de Oncología, Hospital Universitario de Sant Joan de Reus, Esplugues de Llobregat, Barcelona, España.
authors: K
authors: K
authors: Amillano
authors: Servicio de Ginecología y Obstetricia, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España.
authors: M
authors: M
authors: Gomez
authors: Servicio de Medicina Nuclear, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España.
authors: V
authors: V
authors: Izquierdo
authors: Servicio de Ginecología y Obstetricia, Hospital Universitario de Sant Joan de Reus, Esplugues de Llobregat, Barcelona, España.
authors: E
authors: E
authors: Aguilar
authors: Servicio de Cirugía, Hospital Sant Pau y Santa Tecla, Tarragona, España.
authors: S
authors: S
authors: López
authors: Servicio de Cirugía, Hospital del Vendrell, El Vendrell, Tarragona, España.
authors: M
authors: M
authors: Martínez
authors: Servicio de Anatomía Patológica, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España.
authors: S
authors: S
authors: Martínez
authors: Servicio de Cirugía Plástica, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
authors: J M
authors: JM
authors: Serra
authors: Unidad Funcional Interdisciplinar Sociosanitaria cuidados Paliativos, Hospital Universitario de Tarragona Joan XXIII-Gestió i Prestació de Serveis de Salut, Tarragona, España.
authors: M
authors: M
authors: Pérez
authors: Servicio de Radiodiagnóstico, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España.
authors: L
authors: L
authors: Martin
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D013030:Spain
keywords: Axila; Axilla; Breast cancer; Cáncer de mama; False negative rate; Ganglio centinela; Linfadenectomía; Lymphadenectomy; Neoadjuvant chemotherapy; Quimioterapia neoadyuvante; Sentinel node; Tasa de falso negativo