title: Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Patients With an Initial Diagnosis of Cytology-Proven Lymph Node-Positive Breast Cancer.
abstract: Sentinel lymph node biopsy (SNB) is the standard treatment of node-negative breast cancer; however, whether SNB should be performed for patients with node-positive disease before neoadjuvant chemotherapy (NAC) is controversial. We evaluated the accuracy of SNB after NAC in patients with breast cancer with nodal metastasis before chemotherapy to determine the false-negative rate (FNR) and detection rate for SNB.
  
  
  
  In the present multicenter prospective study performed from September 2011 to April 2013, 143 patients with breast cancer and positive axillary nodes, proved by fine needle aspiration cytology at the initial diagnosis (stage T1-T3N1M0), were enrolled. All patients underwent breast surgery with SNB and complete axillary lymph node dissection.
  
  
  
  After NAC, the pathologic complete nodal response rate was 52.4%. The sentinel lymph node could be identified in 130 cases (90.9%); the FNR was 16.0% (13 of 81). The FNR of each clinical subtype was 42.1% (8 of 19) for the estrogen receptor-positive and human epithelial growth factor 2 (HER2)-negative (luminal type), 16.7% (2 of 12) for ER-positive and HER2-positive (luminal-HER2 type), 3.2% (1 of 31) for HER2-positive (HER2-enriched type), and 10.5% (2 of 19) for ER-negative and HER2-negative (triple-negative breast cancer; P = .003). The FNR was significantly greater in the luminal than in the nonluminal type (odds ratio, 9.91; 95% confidence interval, 6.77-14.52).
  
  
  
  SNB after NAC in patients with initially node-positive breast cancer was technically feasible but should not be recommended for the luminal subtype. However, the tumor subtype can guide patient selection, and axillary lymph node dissection could be omitted for the luminal-HER2, HER2-enriched, and triple-negative breast cancer subtypes.
authors.affiliation: Department of Breast Surgical Oncology, Showa University Koto-Toyosu Hospital, Tokyo, Japan. Electronic address: katsueno@hotmail.co.jp.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Enokido
authors.affiliation: Department of Breast Surgical Oncology, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Watanabe
authors.affiliation: Department of Breast Surgical Oncology, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Breast Surgical Oncology, Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ogiya
authors.affiliation: Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Tomo
authors.initials: T
authors.lastname: Osako
authors.affiliation: Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Akiyama
authors.affiliation: Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
authors.forename: Akiyo
authors.initials: A
authors.lastname: Yoshimura
authors.affiliation: Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
authors.forename: Hiroji
authors.initials: H
authors.lastname: Iwata
authors.affiliation: Department of Clinical Oncology, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Ohno
authors.affiliation: Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University Graduate School of Medicine, Kawasaki, Kanagawa, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kojima
authors.affiliation: Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University Graduate School of Medicine, Kawasaki, Kanagawa, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsugawa
authors.affiliation: Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Motomura
authors.affiliation: Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Hideko
authors.initials: H
authors.lastname: Yamauchi
authors.affiliation: Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001365:Axilla; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018579:Patient Selection; D011446:Prospective Studies; D000071036:Sentinel Lymph Node / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy
chemical_list: D000970:Antineoplastic Agents
keywords: Axillary lymph node dissection; Breast cancer; False negative; Lymph node metastasis; Sentinel node biopsy