title: Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with T2 to T4, N0 and N1 breast cancer.
abstract: BACKGROUND
  Histological status of axillary lymph nodes is an important prognostic factor in patients receiving surgery for breast cancer (BC). Sentinel lymph node (SLN) biopsy (B) has rapidly replaced axillary lymph node dissection (ALND), and is now the standard of care for axillary staging in patients with clinically node-negative (N0) operable BC. The aim of this study is to compare pretreatment lymphoscintigraphy with a post primary systemic treatment (PST) scan in order to reduce the false-negative rates for SLNB.
  
  
  METHODS
  In this single-institution study we considered 170 consecutive T2-4 N0-1 M0 BC patients treated with anthracycline-based PST. At the time of incisional biopsy, we performed sentinel lymphatic mapping. After PST, all patients repeated lymphoscintigraphy with the same methodology. During definitive surgery we performed further sentinel lymphatic mapping, SLNB and ALND.
  
  
  RESULTS
  The SLN was removed in 158/170 patients giving an identification rate of 92.9% (95% confidence interval (CI) = 88.0-96.3%) and a false-negative rate of 14.0% (95% CI = 6.3-25.8%). SLNB revealed a sensitivity of 86.0% (95% CI = 74.2-93.7%), an accuracy of 94.9% (95% CI = 90.3-97.8%) and a negative predictive value of 92.7% (95% CI = 86.1-96.8%).
  
  
  CONCLUSIONS
  Identification rate, sensitivity and accuracy are in accordance with other studies on SLNB after PST, even after clinically negative node conversion following PST. This study confirms that diagnostic biopsy and neoadjuvant chemotherapy maintain breast lymphatic drainage unaltered.
authors.affiliation: Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Andreis
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bonardi
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Allevi
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Aguggini
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gussago
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Milani
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Strina
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Spada
authors.affiliation: U.O. di Anatomia Patologica, Azienda Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ferrero
authors.affiliation: U.O. di Anatomia Patologica, Azienda Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ungari
authors.affiliation: Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Rocca
authors.affiliation: Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Nanni
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy; Section of Pharmacology and University Center DIFF - Drug Innovation Forward Future, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25124 Brescia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Roviello
authors.affiliation: Oncologia Medica, Spedali Civili di Brescia, Università di Brescia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Berruti
authors.affiliation: Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DS Oxford, UK.
authors.forename: A L
authors.initials: AL
authors.lastname: Harris
authors.affiliation: Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia.
authors.forename: S B
authors.initials: SB
authors.lastname: Fox
authors.affiliation: Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100 Siena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Roviello
authors.affiliation: Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100 Siena, Italy.
authors.forename: K
authors.initials: K
authors.lastname: Polom
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bottini
authors.affiliation: U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129 Trieste, Italy. Electronic address: daniele.generali@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Generali
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D061305:Lymphoscintigraphy / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011237:Predictive Value of Tests; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic
keywords: Locally advanced breast cancer; Neoadjuvant treatment; Primary systemic therapy; Sentinel lymph node biopsy