KEY TAKEAWAYS
- The study aimed to anticipate the clinical stage based on SLNB and clinicopathological parameters post- NAC in pts with BC.
- Researchers found that SLNB-positive nodes, tumor characteristics, and treatment response could predict no additional positive nodes at ALND.
Sentinel lymph node biopsy (SLNB) has overpowered axillary lymph node dissection (ALND) for the detection of axillary lymph node status in clinically node-negative patients (pts) with breast cancer (BC). However, the strategy of axillary surgery post-neoadjuvant chemotherapy (NAC) treatment is still controversial.
Latif Yilmaz and the team aimed to predict the pathological nodal stage based on SLNB results and the clinicopathological characteristics of pts with BC who initially presented with clinical N1 positivity but were converted to clinical N0 status post-NAC.
Researchers enrolled 150 pts with BC who were receiving NAC and had a clinically confirmed node-negative status. The clinicopathologic parameters and the number of positive lymph nodes in SLNBs and ALNDs were corroborated by using binary/multivariate logistic regression analysis.
Results revealed that among 150 pts, 78 had negative- SLNBs, while 72 had positive SLNBs. Among the 21 patients with SLNB1-positive status who underwent ALND, 80.8% had no additional node involvement, 19.2% had 1-2 positive lymph nodes, and none had ≥ 3 lymph nodes involved.
The rate of negative non-sentinel nodes was 75% in the luminal A/B subgroup, 100% in the HER-2-positive subgroup, and 100% in the triple-negative subgroup. Those pts with BC with a lower T stage (T1-3 vs. T4), fewer than 4 clinical nodes before NAC (< 4 vs. ≥4), and a decreased postoperative Ki-67 index (< 10% vs. stable/increase) were included.
Univariate and multivariate analyses indicated that being in the triple-negative or HER2-positive subgroup, compared to the luminal A/B subgroup, was predictive of a complete lymph node response in pts with BC.
The study concluded that the number of SLNB-positive nodes, tumor-related parameters, and response to treatment may predict no additional nodes to be positive at ALND.
The study did not receive any external funding.
Source: https://pubmed.ncbi.nlm.nih.gov/39030524/
Yilmaz L, Kus T, Aytekin A, et al. (2024). “Prediction of the number of positive axillary lymph nodes according to sentinel lymph node involvement and biological subtypes in patients receiving neoadjuvant chemotherapy.” BMC Surg. 2024 Jul 19;24(1):213. doi: 10.1186/s12893-024-02500-5. PMID: 39030524; PMCID: PMC11264838.
