Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection
Abigail S. Caudle,Wei T. Yang,Savitri Krishnamurthy,Elizabeth A. Mittendorf,Dalliah M. Black,Michael Z. Gilcrease,Isabelle Bedrosian,Brian P. Hobbs,Sarah M. DeSnyder,Rosa F. Hwang,Beatriz E. Adrada,Simona F. Shaitelman,Mariana Chavez-MacGregor,Benjamin Smith,Rosalind P. Candelaria,Gildy Babiera,Basak E. Dogan,Lumarie Santiago,Kelly K. Hunt,Henry Mark Kuerer +19 more
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TLDR
Marking nodes with biopsy-confirmed metastatic disease allows for selective removal and improves pathologic evaluation for residual nodal disease after chemotherapy, as determined in patients undergoing complete axillary lymphadenectomy.Abstract:
PurposePlacing clips in nodes with biopsy-confirmed metastasis before initiating neoadjuvant therapy allows for evaluation of response in breast cancer. Our goal was to determine if pathologic changes in clipped nodes reflect the status of the nodal basin and if targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of clipped nodes, improves the false-negative rate (FNR) compared with SLND alone.MethodsA prospective study of patients with biopsy-confirmed nodal metastases with a clip placed in the sampled node was performed. After neoadjuvant therapy, patients underwent axillary surgery and the pathology of the clipped node was compared with other nodes. Patients undergoing TAD had SLND and selective removal of the clipped node using iodine-125 seed localization. The FNR was determined in patients undergoing complete axillary lymphadenectomy (ALND).ResultsOf 208 patients enrolled in this study, 191 underwent ALND, with residual dise...read more
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Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Elżbieta Senkus,Stella Kyriakides,Frédérique Penault-Llorca,P.M. Poortmans,Alexander J. Thompson,Sophia Zackrisson,Fatima Cardoso +6 more
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Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype.
W. Fraser Symmans,Caimiao Wei,Rebekah Gould,Xian Yu,Ya Zhang,Mei Liu,Andrew Walls,Alex Bousamra,Maheshwari Ramineni,Bruno Valentin Sinn,Kelly K. Hunt,Thomas A. Buchholz,Vicente Valero,Aman U. Buzdar,Wei Yang,Abenaa M. Brewster,Stacy L. Moulder,Lajos Pusztai,Christos Hatzis,Gabriel N. Hortobagyi +19 more
TL;DR: Continuous RCB index was prognostic for long-term survival after neoadjuvant chemotherapy in all three phenotypic subsets of breast cancer and stratified prognostic risk overall, within each phenotypesic subset, and within yp-stage categories.
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How Often Does Neoadjuvant Chemotherapy Avoid Axillary Dissection in Patients With Histologically Confirmed Nodal Metastases? Results of a Prospective Study
Anita Mamtani,Andrea V. Barrio,Tari A. King,Kimberly J. Van Zee,George Plitas,Melissa Pilewskie,Mahmoud El-Tamer,Mary L. Gemignani,Alexandra S. Heerdt,Lisa M. Sclafani,Virgilio Sacchini,Hiram S. Cody,Sujata Patil,Monica Morrow +13 more
TL;DR: Nearly 70 % of the N+ patients were eligible for SLNB after NAC, and for 48 %, ALND was avoided, supporting the role of NAC in reducing the need for ALND among patients presenting with nodal metastases.
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Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology.
William J. Gradishar,Meena S. Moran,Jame Abraham,Rebecca Aft,Doreen M. Agnese,Kimberly H. Allison,Bethany Anderson,Harold J. Burstein,Helen K. Chew,Chau T. Dang,Anthony D. Elias,Sharon H. Giordano,Matthew P. Goetz,Lori J. Goldstein,Sara A. Hurvitz,Steven J. Isakoff,Rachel C. Jankowitz,Sara H. Javid,Jairam Krishnamurthy,Marilyn Leitch,Janice A. Lyons,Joanne E. Mortimer,Sameer A. Patel,Lori J. Pierce,Laura H. Rosenberger,Hope S. Rugo,Amy Sitapati,Karen Smith,Mary Lou Smith,Hatem Soliman,Erica Stringer-Reasor,Melinda L. Telli,John R. Ward,Kari B. Wisinski,Jessica Young,Jennifer L. Burns,Rashmi Kumar +36 more
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Axillary Nodal Management Following Neoadjuvant Chemotherapy: A Review.
Melissa Pilewskie,Monica Morrow +1 more
TL;DR: Sentinel lymph node biopsy after NAC in patients presenting with clinically negative nodes has an accuracy similar to upfront SLNB and reduces the need for axillary lymph node dissection compared with SLNB prior to NAC, and SLNB is an accurate method of determining nodal status after Nac.
References
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Significantly Higher Pathologic Complete Remission Rate After Neoadjuvant Therapy With Trastuzumab, Paclitaxel, and Epirubicin Chemotherapy: Results of a Randomized Trial in Human Epidermal Growth Factor Receptor 2–Positive Operable Breast Cancer
Aman U. Buzdar,Nuhad K. Ibrahim,Deborah Francis,Daniel J. Booser,Eva Thomas,Richard L. Theriault,Lajos Pusztai,Marjorie C. Green,Banu Arun,Sharon H. Giordano,Massimo Cristofanilli,Debra Frye,Terry L. Smith,Kelly K. Hunt,Sonja E. Singletary,Aysegul A. Sahin,Michael S. Ewer,Thomas A. Buchholz,Donald A. Berry,Gabriel N. Hortobagyi +19 more
TL;DR: Adding trastuzumab to chemotherapy, as used in this trial, significantly increased pathologic complete response (pCR) rate without clinical congestive heart failure, according to the small sample size.
Journal ArticleDOI
Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy in Patients With Node-Positive Breast Cancer: The ACOSOG Z1071 (Alliance) Clinical Trial
Judy C. Boughey,Vera J. Suman,Elizabeth A. Mittendorf,Gretchen M. Ahrendt,Lee G. Wilke,Bret Taback,A. Marilyn Leitch,Henry Mark Kuerer,Monet Bowling,Teresa S. Flippo-Morton,David R. Byrd,David W. Ollila,Thomas B. Julian,Sarah A. McLaughlin,Linda M. McCall,W. Fraser Symmans,Huong T. Le-Petross,Bruce G. Haffty,Thomas A. Buchholz,Heidi Nelson,Kelly K. Hunt +20 more
TL;DR: The application of SLN surgery for staging the axilla following chemotherapy for women who initially had node-positive cN1 breast cancer is unclear because of high false-negative results reported in previous studies as mentioned in this paper.
Journal ArticleDOI
Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study
Thorsten Kuehn,Ingo Bauerfeind,Tanja Fehm,Barbara Fleige,Maik Hausschild,Gisela Helms,Annette Lebeau,Cornelia Liedtke,Gunter von Minckwitz,Valentina Nekljudova,Sabine Schmatloch,P Schrenk,Annette Staebler,Michael Untch +13 more
TL;DR: Sentinel-lymph-node biopsy is a reliable diagnostic method before neoadjuvant chemotherapy and after systemic treatment or early sentinel-allymph- node biopsy, the procedure has a lower detection rate and a higher false-negative rate compared with sentinel
Journal ArticleDOI
Surgical Complications Associated With Sentinel Lymph Node Dissection (SLND) Plus Axillary Lymph Node Dissection Compared With SLND Alone in the American College of Surgeons Oncology Group Trial Z0011
Anthony Lucci,Linda M. McCall,Peter D. Beitsch,Patrick W. Whitworth,Douglas S. Reintgen,Peter W. Blumencranz,A. Marilyn Leitch,Sukumal Saha,Kelly K. Hunt,Armando E. Giuliano +9 more
TL;DR: Complications associated with SLN dissection (SLND) plus ALND, versus SLND alone resulted in more wound infections, axillary seromas, and paresthesias thanSLND alone, and the use of SLNDalone resulted in fewer complications.
Journal ArticleDOI
Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study.
Jean-Francois Boileau,Brigitte Poirier,Mark Basik,Claire M. B. Holloway,Louis Gaboury,Lucas Sideris,Sarkis Meterissian,Angel Arnaout,Muriel Brackstone,David R. McCready,Stephen E. Karp,Isabelle Trop,Andre Lisbona,Frances C. Wright,Rami Younan,Louise Provencher,Erica Patocskai,Atilla Omeroglu,André Robidoux +18 more
TL;DR: It is recommended that SN evaluation with IHC be further evaluated before being included in future guidelines on the use of SNB after NAC in this setting, and a low SNB FNR (8.4%) can be achieved with mandatory use of IHC.
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