Annals of Surgical Oncology

, Volume 15, Issue 11, pp 3252–3258 | Cite as

Axillary Staging Prior to Neoadjuvant Chemotherapy for Breast Cancer: Predictors of Recurrence

  • Kandice E. Kilbride
  • M. Catherine Lee
  • Alexis V. Nees
  • Vincent M. Cimmino
  • Kathleen M. Diehl
  • Michael S. Sabel
  • Daniel F. Hayes
  • Anne F. Schott
  • Celina G. Kleer
  • Alfred E. Chang
  • Lisa A. Newman
Breast Oncology



The value of axillary staging prior to delivery of neoadjuvant chemotherapy (NEO) for breast cancer is controversial. Our goal was to analyze the prognostic and therapeutic impact of axillary staging on recurrence.


The study cohort included 161 patients undergoing comprehensive evaluation by a multidisciplinary approach during the period 1996–2006. Clinicopathologic features were assessed before and after delivery of NEO. Patients with node-positive disease before NEO underwent a post-NEO axillary lymph node dissection at time of definitive breast surgery.


At presentation, median age was 49 years; mean tumor size was 45 mm. The axilla was negative in 45 (28.6%) patients. Of the 114 pre-NEO node-positive patients, 65 (57%) were staged histologically. At completion of NEO, partial or complete clinical response was observed in 90.6%; complete pathologic response occurred in 23.6%. Mean residual tumor size was 10.5 mm. Of the 112 initially node-positive patients, 36 (31.6%) had no residual axillary disease post NEO. At median follow-up of 38.1 months, 21.7% patients relapsed. The pre-NEO nodal status was the strongest predictor of treatment failure. A significant risk of distant relapse was based on nodal response to NEO: 8.1% in node-negative patients, 13.9% in the downstaged group, and 22.1% in the persistently positive group (P = 0.047). Delivery of nodal irradiation decreased local recurrence in the downstaged group (12.5% versus 3.7%, P = NS).


Our experience suggests that comprehensive axillary staging with ultrasound and fine-needle aspiration (FNA) and sentinel lymph node biopsy prior to NEO is both prognostically and therapeutically important in predicting those patients at higher risk of recurrence.


Sentinel Lymph Node Biopsy Nodal Basin Distant Failure Nodal Irradiation Axillary Staging 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This project was supported in part by an Interdisciplinary Breast Fellowship Grant from the Susan G. Komen for the Cure Foundation.


  1. 1.
    Buchholz TA, Hunt KK, Whitman GJ, et al. Neoadjuvant chemotherapy for breast carcinoma: multidisciplinary considerations of benefits and risks. Cancer 2003;98:1150–60PubMedCrossRefGoogle Scholar
  2. 2.
    Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjvant Breast and Bowel Project B–18. J Clin Oncol 1997;15:2483–93PubMedGoogle Scholar
  3. 3.
    Lyman GH, Guiliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005;23:7703–20PubMedCrossRefGoogle Scholar
  4. 4.
    Krishnamurthy S, Sneige N, Bedi DG, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer 2002;95:982–8PubMedCrossRefGoogle Scholar
  5. 5.
    van Rijk MC, Deurloo EE, Nieweg OE, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol 2005;13:31–5CrossRefGoogle Scholar
  6. 6.
    Gilissen F, Oostenbroek R, Storm R, et al. Prevention of futile sentinel node procedures in breast cancer: ultrasonography of the axilla and fine-needle aspiration cytology are obligatory. Eur J Surg Oncol 2007, doi: 10.1016/j.ejso.2007.07.198
  7. 7.
    Popli MB, Sahoo M, Mehrotra N, et al. Preoperative ultrasound-guided fine-needle aspiration cytology for axillary staging in breast carcinoma. Australas Radiol 2006;50:122–6PubMedCrossRefGoogle Scholar
  8. 8.
    Sahoo S, Sanders MA, Roland L, et al. A strategic approach to the evaluation of axillary lymph nodes in breast cancer patients: analysis of 168 patients at a single institution. Am J Surg 2007;194:524–6PubMedCrossRefGoogle Scholar
  9. 9.
    Yamamoto M, Mehta RS, Baick CH, et al. The predictive value of sentinel lymph node biopsy in locally advanced breast cancer patients who have undergone neoadjuvant chemotherapy. Am J Surg 2007;73:977–80Google Scholar
  10. 10.
    Newman EA, Sabel MS, Nees AV, et al. Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation. Ann Surg Oncol 2007;14:2946–52PubMedCrossRefGoogle Scholar
  11. 11.
    Mamounas EP, Brown A, Anderson S, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from the National Surgical Adjuvant Breast and Bowel Project B-27. J Clin Oncol 2005;23:2694–702PubMedCrossRefGoogle Scholar
  12. 12.
    Jones JL, Zabicki K, Christian RL, et al. A comparison of sentinel node biopsy before and after neoadjuvant chemotherapy: timing is important. Am J Surg 2005;190:517–20PubMedCrossRefGoogle Scholar
  13. 13.
    Lang JE, Esserman LJ, Ewing CA, et al. Accuracy of selective sentinel lymphadenectomy after neoadjuvant chemotherapy: effect of clinical node status on presentation. J Am Coll Surg 2004;199:856–62PubMedCrossRefGoogle Scholar
  14. 14.
    Brady EW. Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer. Breast J 2002;8:97–100PubMedCrossRefGoogle Scholar
  15. 15.
    Stearns V, Ewing CA, Slack R, et al. Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol 2002;9:235–42PubMedCrossRefGoogle Scholar
  16. 16.
    Julian TB, Patel N, Dusi D, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer. Am J Surg 2001;182:407–10PubMedCrossRefGoogle Scholar
  17. 17.
    Fernandez A, Cortes M, Benito E, et al. Gamma probe sentinel node localization and biopsy in breast cancer patients treated with a neoadjuvant chemotherapy scheme. Nucl Med Commun 2001;22:361–6PubMedCrossRefGoogle Scholar
  18. 18.
    Tafra L, Verbanac KM, Lannin DR. Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer. Am J Surg 2001;182:312–5PubMedCrossRefGoogle Scholar
  19. 19.
    Nason KS, Anderson BO, Byrd DR, et al. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 2000;89:2187–94PubMedCrossRefGoogle Scholar
  20. 20.
    Cohen LF, Breslin TM, Kuerer HM, et al. Identification and evaluation of axillary sentinel lymph nodes in patients with breast carcinoma treated with neoadjuvant chemotherapy. Am J Surg Pathol 2000;24:1266–72PubMedCrossRefGoogle Scholar
  21. 21.
    Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol 2000;18:3480–6PubMedGoogle Scholar
  22. 22.
    Cox CE, Cox JM, White LB, et al. Sentinel node biopsy before neoadjuvant chemotherapy for determining axillary status and treatment prognosis in local advanced breast cancer. Ann Surg Oncol 2006;13:483–90PubMedCrossRefGoogle Scholar
  23. 23.
    Kuerer HM, Sahin AA, Hunt KK, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastasis before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg 1999;230:72–8PubMedCrossRefGoogle Scholar
  24. 24.
    Rouzier R, Extra JM, Klijanienko J, et al. Incidence of prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J Clin Oncol 2002;20:1304–10PubMedCrossRefGoogle Scholar
  25. 25.
    Khan A, Sabel MS, Nees A, et al. Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel lymph node biopsy. Ann Surg Oncol 2005;12:697–704PubMedCrossRefGoogle Scholar
  26. 26.
    Schrenk P, Hochreiner G, Fridrik M, et al. Sentinel node biopsy performed before preoperative chemotherapy for axillary lymph node staging in breast cancer. Breast J 2003;9:282–7PubMedCrossRefGoogle Scholar
  27. 27.
    van Rijk MC, Nieweg OE, Rutgers EJT, et al. Sentinel node biopsy before neoadjuvant chemotherapy spares breast cancer patients axillary lymph node dissection. Ann Surg Oncol 2006;13:475–9. PubMedCrossRefGoogle Scholar
  28. 28.
    McGuire SE, Gonzalez-Angulo AM, Huang EH, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys 2007;68:1004–9. PubMedGoogle Scholar
  29. 29.
    Sabel MS, Schott AF, Kleer CG, et al. Sentinel node biopsy prior to neoadjuvant chemotherapy. Am J Surg 2003;186:102–5. PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Kandice E. Kilbride
    • 1
  • M. Catherine Lee
    • 2
  • Alexis V. Nees
    • 3
  • Vincent M. Cimmino
    • 1
  • Kathleen M. Diehl
    • 1
  • Michael S. Sabel
    • 1
  • Daniel F. Hayes
    • 4
  • Anne F. Schott
    • 4
  • Celina G. Kleer
    • 5
  • Alfred E. Chang
    • 1
  • Lisa A. Newman
    • 1
  1. 1.Department of Surgical OncologyUniversity of MichiganAnn ArborUSA
  2. 2.Department of Surgery, Comprehensive Breast Cancer ProgramH. Lee Moffitt Cancer CenterTampaUSA
  3. 3.Department of RadiologyUniversity of MichiganAnn ArborUSA
  4. 4.Department of Medical OncologyUniversity of MichiganAnn ArborUSA
  5. 5.Department of PathologyUniversity of MichiganAnn ArborUSA

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