Feasibility, accuracy and prognosis of sentinel lymph node biopsy before neoadjuvant therapy in breast cancer. A prospective study.
OBJECTIVE
It remains controversial whether sentinel lymph node biopsy (SLNB) should be performed before or after neoadjuvant therapy (NAT). We aimed to evaluate the feasibility and accuracy of SLNB before NAT at a single institution, and to determine its relation to patient prognosis.


METHODS
A prospective study of T1c-T2-T3 N0 breast cancer patients, after ultrasound examination, who underwent SLNB prior to NAT. Overall, disease-specific and disease-free survival were calculated by Kaplan-Meier curves.


RESULTS
SLNB before NAT was performed in 123 patients from December 2006 to May 2014. The identification rate was 100%. SLNB was positive in 42.3% of cases (27.6% macrometastases). NAT was chemotherapy in 88.6% of cases and endocrine-therapy in 11.4%. Lymphadenectomy was avoided in 72.4% of cases. Median follow-up was 40 months (range 8-100). Overall and disease-free survival was 90.2% and 88.6% respectively.SLN involvement was not related to patient outcome (p 0.72); however there were significant differences in survival according to molecular-like subtypes (p < 0.025) and NAT response (p < 0.0001).


CONCLUSIONS
SLNB prior to NAT is an accurate method of axillary staging associated with a high identification rate. It avoided lymphadenectomy in more than 70% of patients. SLN involvement did not worsen the prognosis in our cohort.
Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain. Electronic address: agarciat@bellvitgehospital.cat.
Amparo
A
Garcia-Tejedor
Department of Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain.
Catalina
C
Falo
Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Cecilia
C
Quetglas
Department of Pathology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Teresa
T
Soler
Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Belen
B
Marqueta
Department of Radiology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Raul
R
Ortega
Department of Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain.
Miguel
M
Gil-Gil
Department of Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain.
Sonia
S
Pernas
Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Eulalia
E
Fernandez-Montolí
Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Maria J
MJ
Pla
Department of Radiology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Anna
A
Guma
Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit Hospital, Universitari Bellvitge, Idibell, Barcelona, Spain.
Maite
M
Bajen
Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit Hospital, Universitari Bellvitge, Idibell, Barcelona, Spain.
Ana
A
Benitez
Department of Oncological Radiotherapy, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncología, Barcelona, Spain.
Arantxa
A
Eraso
Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Miriam
M
Campos
Department of Pathology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Anna
A
Petit
Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain.
Jordi
J
Ponce
D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013997:Time Factors
Breast cancer; Neoadjuvant chemotherapy; Neoadjuvant endocrine therapy; Sentinel lymph node biopsy