Oops, you're using an old version of your browser so some of the features on this page may not be displaying properly.

MINIMAL Requirements: Google Chrome 24+Mozilla Firefox 20+Internet Explorer 11Opera 15–18Apple Safari 7SeaMonkey 2.15-2.23

Poster lunch

1975 - Outcomes of Sentinel Lymph Node biopsy after neoadjuvant chemotherapy (70P)

Date

18 Nov 2017

Session

Poster lunch

Presenters

Sadaf Rashad

Citation

Annals of Oncology (2017) 28 (suppl_10): x16-x24. 10.1093/annonc/mdx655

Authors

A. Bulbul1, S. Rashad1, E.A. Mino1, A. Bautista1, A. Mustafa2, S. Chouial1, M. Khorsand1

Author affiliations

  • 1 Hematology/oncology, Kymera Cancer Center-Carlsbad, 88220 - Carlsbad/US
  • 2 Anesthesiology, Acharya Shri Chander College of Medical Sciences, Jammu/IN
More

Resources

Abstract 1975

Background

Axillary sentinel lymph node biopsy (SLNB) is a single lymph node or first set of nodes that receive direct lymphatic drainage from a primary tumor. The number of nodes examined, minimal surgeon experience may increase false negative rates (FNR), the results reported in the literature are however inconsistent. The adequate number of SLN required for achieving a low FNR remains controversial especially those receiving neoadjuvant chemotherapy (NAC).

Methods

We retrospectively evaluated 539 patients between Jan 1989 – Oct 2015, Median age 64 (30 – 91) with a median follow-up of 8.9 (0.03, 26.8) years. SLNB was performed post NAC in 210 clinically N0 breast cancers by community breast surgeons across three rural surgical practices. Logistical regression analysis was used to assess the relationship of recurrence with SLNB using SAS ver.9.3. FNR was calculated by evaluating 70/210 patients who received AD (Axillary dissection) post SLNB and were found to have positive nodes on AD. Technique used for SLNB was recorded.

Results

Six patients had positive nodes on AD despite a negative SLNB yielding an overall FNR of 8.5% (6/70) post NAC. All FN patients had ≤ 2 SLNs removed, they were in Isosulfan blue dye (IBD) group and had a Ki67>10%. The number of SLNs identified ranged from 1 to 9 (mean, 2.2; median 2). FNR for 2 or more SLNs removed was 2.8% (2/70), above 3 SLNs FNR was 0%. Three patients had SLNB failure (no nodes detected). (IBD) was used in 83/198 (42%), technetium sulfur colloid (TSC) in 101/198 (51%) both 12/198 (6%). Among patient with SLNB, the local recurrence was 5.34%. No adjuvant radiation increased the likelihood of LR by 2.92-fold. LR rates were similar with IBD or TSC (p = 0.79).

Conclusions

FNR of 2.8% or lower can be achieved with surgeons in rural practices with limited volumes if ≥ 2 SLN are removed. LR rates were consistent with Z-0011. Surgeons in our study preferred mostly blue dye due to cost issues and does not affect LR. Excisional biopsies tend to be common in rural practices although not recorded in our study may also have a role to play since disruption may alter the lymphatic flow leading to FNR. We hypothesize that there might be an optimal threshold number of SLNs removed to achieve acceptable FNR 0-5% if 2-3 SLNs are removed. NAC had acceptable overall FNR of 8.5%.

Clinical trial identification

Legal entity responsible for the study

Kymera Independent Physicians

Funding

None

Disclosure

All authors have declared no conflicts of interest.

This site uses cookies. Some of these cookies are essential, while others help us improve your experience by providing insights into how the site is being used.

For more detailed information on the cookies we use, please check our Privacy Policy.

Customise settings
  • Necessary cookies enable core functionality. The website cannot function properly without these cookies, and you can only disable them by changing your browser preferences.