Adequate sentinel node harvest is associated with low false negative rate in breast cancer managed with neoadjuvant chemotherapy and targeted axillary dissection

• Published in: The American journal of surgery Vol. 219; no. 5; pp. 851 - 854
• Main Authors: Sutton, Thomas L., Johnson, Nathalie, Garreau, Jennifer R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2020; Elsevier Limited
• Subjects: Biopsy; Breast cancer; Cancer therapies; Chemotherapy; Cost analysis; Dissection; Identification; Localization; Lymph nodes; Lymphatic system; Metastasis; Nodes; Pathology; Patients; Studies; Targeted axillary dissection; Targeted axillary dissection; Breast cancer
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.03.012

After neoadjuvant chemotherapy (NAC) for clinically node-positive breast cancer (NPBC), targeted axillary dissection (TAD) reduces the false negative rate (FNR) of axillary node sampling. Axillary lymph node dissection (ALND) is indicated if the clipped node cannot be identified. Prior studies have indicated that a sentinel lymph node harvest (SLNH) of ≥3 also leads to low FNR. We investigated the performance of SLNH thresholds at inferring the status of the axilla during TAD. Retrospective review of the Legacy Health System Tumor Registry was performed. We identified NPBC patients between 2011 and 2016 managed with NAC and TAD. In 29 patients, the FNR of the SLNB component of TAD was 11% with SLNH of ≥3; with SLNH of ≤2 nodes the FNR was 20%. In patients with NPBC receiving NAC, adequate SLNH is associated with acceptably low FNR. The decision to pursue ALND for clip identification should be made on a case-by-case basis. •Adjuvant localization techniques for the clipped node in targeted axillary dissection are increasing in use, but can fail due to technical or device-specific errors.•In patients undergoing TAD, a harvest of 3 or greater sentinel lymph nodes can accurately predict the disease status of the axilla with a low false negative rate.•With adequate lymph node harvest, the oncologic benefit of axillary lymph node dissection for clip identification should be considered on a case by case basis.