Our Summary

This research paper discusses a study on the use of sentinel lymph node biopsy (SLNB) - a method to determine if breast cancer has spread to the lymph nodes - following chemotherapy in patients who already have cancer in their lymph nodes. The study compiled data from 19 articles, totaling 3,398 patients.

The results showed that the method of SLNB after chemotherapy had a 13% rate of providing false negative results, but had a 91% success rate in identifying the sentinel lymph node. In addition, they found that around 47% of patients showed no signs of cancer in their lymph nodes after chemotherapy.

The researchers also noticed a trend that patients with only stage N1 disease (the least advanced form of node-positive breast cancer) had a higher chance of having no signs of cancer in their lymph nodes after chemotherapy compared to those with more advanced stages.

The paper concludes that using SLNB after chemotherapy is a reasonable alternative strategy to the more invasive axillary dissection (surgery that removes lymph nodes in the armpit). However, the researchers note that better patient selection and improved techniques could further reduce the likelihood of false negatives and increase the success rate of locating the sentinel lymph node.

FAQs

  1. What is the false negative rate (FNR) and identification rate (IR) for sentinel lymph node biopsy (SLNB) in patients treated with neoadjuvant chemotherapy (NAC)?
  2. How does the clinical stage of the disease influence the pathological complete response (pCR) rate when using sentinel lymph node biopsy following neoadjuvant chemotherapy?
  3. Can sentinel lymph node biopsy be considered a valid alternative to axillary dissection in node-positive patients after neoadjuvant chemotherapy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sentinel lymph node biopsy is to ensure they follow all pre-operative instructions provided by their healthcare team, such as avoiding certain medications or foods before the procedure. Additionally, patients should communicate any concerns or questions they have with their healthcare provider to ensure they are well-informed about the procedure and its potential outcomes.

Suitable For

Patients who are typically recommended sentinel lymph node biopsy are those with clinically node-positive breast cancer who have undergone neoadjuvant chemotherapy. The use of SLNB in these patients can provide information on the extent of lymph node involvement and guide further treatment decisions. It is important to note that more refined patient selection and optimal techniques can help improve the accuracy of SLNB in this patient population.

Timeline

Before sentinel lymph node biopsy:

  • Patient presents with clinically positive lymph nodes
  • Patient undergoes neoadjuvant chemotherapy
  • Imaging studies may be performed to assess response to chemotherapy
  • Decision is made to proceed with sentinel lymph node biopsy after NAC

After sentinel lymph node biopsy:

  • Sentinel lymph node identification rate is 91%
  • False negative rate is 13%
  • Axillary pathological complete response rate is 47%
  • Trend towards significance with only clinical stage N1 disease
  • SLNB is considered a valid alternative to axillary dissection in this patient population
  • Refining patient selection and optimal techniques can improve FNR and IR.

What to Ask Your Doctor

  1. What is the purpose of a sentinel lymph node biopsy in my case?
  2. What is the false negative rate for sentinel lymph node biopsy in patients who have received neoadjuvant chemotherapy?
  3. What is the likelihood of identifying the sentinel lymph node during the biopsy procedure?
  4. How does the presence of clinically positive lymph nodes affect the accuracy of the sentinel lymph node biopsy results?
  5. What are the potential risks and complications associated with a sentinel lymph node biopsy?
  6. How does the information obtained from the sentinel lymph node biopsy impact my treatment plan?
  7. Are there any alternative options to a sentinel lymph node biopsy in my case?
  8. How can we ensure the most accurate and successful results from the sentinel lymph node biopsy procedure?
  9. What is the likelihood of achieving a pathological complete response in the axillary lymph nodes after neoadjuvant chemotherapy and a sentinel lymph node biopsy?
  10. How will the results of the sentinel lymph node biopsy influence my long-term prognosis and follow-up care?

Reference

Authors: El Hage Chehade H, Headon H, El Tokhy O, Heeney J, Kasem A, Mokbel K. Journal: Am J Surg. 2016 Nov;212(5):969-981. doi: 10.1016/j.amjsurg.2016.07.018. Epub 2016 Aug 16. PMID: 27671032