The aim of the study is to evaluate the optimal timing of sentinel lymph node biopsy (SLNB) in patients with clinical negative axillary lymph nodes (ALNs) before neoadjuvant therapy (NAT) and the feasibility of SLNB substituting for ALN dissection in patients with positive ALNs who convert to node negative, for HER2-positive disease.
Patients receiving SLNB with dual tracer mapping in the PEONY trial were analyzed.
For 80 patients with clinical negative ALNs, the node negative rate by pathology after NAT was 83.8%. SLNB was performed after NAT in 71 patients. The identification rate of sentinel lymph nodes (SLNs) was 100%. For patients with positive ALNs before NAT, the axillary pathologic complete response rate in the dual HER2 blockade arm was significantly higher than that in the single blockade arm (p = 0.002). SLNB was performed in 71 patients. The identification rate was 100% and the false-negative rate was 17.2%. The false-negative rates were 33.3%, 14.3%, and 0 when 1, 2, and more than 2 SLNs were detected. There was no false-negative case when more than 1 SLN and the clipped nodes were removed simultaneously.
For clinical ALN negative patients, HER2-positive subtype is found to have high node negative rate by pathology and it is recommended to undergo SLNB after NAT. For patients with positive ALNs who convert to negative, the false-negative rate is high. Dual tracer mapping, more than 2 SLNs detected, more than 1 SLN identified plus the clips placed are the guarantees for lower false-negative rate.
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Fisher B, Brown A, Mamounas E et al (1997) Effect of preoperative chemotherapy on local regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–2493. https://doi.org/10.1200/JCO.1922.214.171.1243
Shao Z, Pang D, Yang H et al (2019) Efficacy, safety, and tolerability of pertuzumab, trastuzumab, and docetaxel for patients with early or locally advanced ERBB2-positive breast cancer in Asia: the PEONY Phase 3 Randomized Clinical Trial. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2019.3692
Kumar A, Puri R, Gadgil PV et al (2012) Sentinel lymph node biopsy in primary breast cancer: window to management of the axilla. World J Surg 36:1453–1459. https://doi.org/10.1007/s00268-012-1635-8
Gentile LF, Plitas G, Zabor EC et al (2017) Tumor biology predicts pathologic complete response to neoadjuvant chemotherapy in patients presenting with locally advanced breast cancer. Ann Surg Oncol 24:3896–3902. https://doi.org/10.1245/s10434-017-6085-y
Boughey JC, McCall LM, Ballman KV et al (2014) Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg 260:608–614. https://doi.org/10.1097/SLA.0000000000000924
Gianni L, Pienkowshi T, Im YH et al (2012) Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol 13:25–32. https://doi.org/10.1016/S1470-2045(11)70336-9
Giuliano AE, Ballman KV, McCall L et al (2017) Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA 318:918–926. https://doi.org/10.1001/jama.2017.11470
Donker M, van Tienhoven G, Straver ME et al (2014) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 15:1303–1310. https://doi.org/10.1016/S1470-2045(14)70460-7
Grasishar WJ, Anderson BO, Balassanian R et al (2017) Breast Cancer, Version 3.2017 featured updates to the NCCN Guidelines. National Comprehensive Cancer Network. https://www.NCCN.org. Accessed 10 Nov 2017
Grasishar WJ, Anderson BO, Balassanian R et al (2020) Breast Cancer, Version 1.2020 featured updates to the NCCN Guidelines. National Comprehensive Cancer Network. https://www.NCCN.org. Accessed 15 Jan 2020
Curigliano G, Burstein H, Winer E et al (2017) De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer. Ann Oncol 28:1700–1712. https://doi.org/10.1093/annonc/mdy537
Burstein HJ, Curigliano G, Loibl S et al (2019) Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019. Ann Oncol 30:1541–1557. https://doi.org/10.1093/annonc/mdz235
von Minckwitz G, Huang C-S, Mano MS et al (2019) Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med 380:617–628. https://doi.org/10.1056/NEJMoa1814017
Shi ZQ, Qiu PF, Liu YB et al (2019) Neoadjuvant chemotherapy and axillary de-escalation management for patients with clinically node-negative breast cancer. Breast J 25:1154–1159. https://doi.org/10.1111/tbj.13422
Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553. https://doi.org/10.1056/NEJMoa012782
Krag DN, Anderson SJ, Julian TB et al (2010) Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 11:927–933. https://doi.org/10.1016/S1470-2045(10)70207-2
Mansel RE, Fallowfield L, Kissin M et al (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 98:599–609. https://doi.org/10.1093/jnci/djj158
Boughey JC, Suman VJ, Mittendorf EA et al (2013) Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) Clinical Trial. JAMA 310:1455–1461. https://doi.org/10.1001/jama.2013.278932
Kuehn T, Bauerfeind I, Fehm T et al (2013) Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENATINA): a prospective, multicentre cohort study. Lancet Oncol 14:609–618. https://doi.org/10.1016/S1470-2045(13)70166-9
Boileau JF, Poirier B, Basik M et al (2015) Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol 33:258–264. https://doi.org/10.1200/JCO.2014.55.7827
El Hage CH, Headon H, El Tokhy O et al (2016) Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients. Am J Surg 212:969–981. https://doi.org/10.1016/j.amjsurg.2016.07.018
Hunt KK, Yi M, Mittendorf EA et al (2009) Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients. Ann Surg 250:558–566. https://doi.org/10.1097/SLA.0b013e3181b8fd5e
Nason KS, Anderson BO, Byrd DR et al (2000) Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 89:2187–2194
Caudle AS, Yang WT, Krishnamurthy S et al (2016) Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol 34:1072–1078. https://doi.org/10.1200/JCO.2015.64.0094
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The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional Research Committee and/or National Research Committee (National Medical Products Administrator 2015L01504, Fudan University Shanghai Cancer Center 150915–2, Shandong Cancer Hospital Affiliated to Shandong University 201512002) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Sun, X., Wang, X., Zhang, Z. et al. Neoadjuvant therapy and sentinel lymph node biopsy in HER2-positive breast cancer patients: results from the PEONY trial. Breast Cancer Res Treat (2020). https://doi.org/10.1007/s10549-020-05559-9
- Breast cancer
- Neoadjuvant therapy
- Sentinel lymph node biopsy
- Pathologic complete response