The experience of sentinel lymph node biopsy in Chinese breast cancer patients with prior neo-adjuvant chemotherapy

Abstract

Objective: Sentinel lymph node biopsy (SLNB) is well accepted as part of management of early breast cancer. As neo-adjuvant chemotherapy (NACT) is increasingly used in management of locally advanced breast cancer (LABC), breast conservative surgery has become a possibility even for patients who initially present with large tumours. However reports on the performance of sentinel lymph node biopsy (SLNB) following neo-adjuvant chemotherapy (NACT) have been conflicting. In addition, limited number of reports from Chinese breast cancer patients are available. This study aims to evaluate the results of SLNB after neo-adjuvant chemotherapy in Chinese breast cancer patients. Methods: A retrospective study was performed for breast cancer patients who had SLNB after prior neo-adjuvant chemotherapy. Adriamycin-based or taxane-based chemotherapy was given as neo-adjuvant treatment. A combination of radiopharmaceutical 99mTc-albumin colloid and Patent Blue V dye was used to identify the sentinel lymph node (SLN). SLNB was followed by standard axillary dissection in all patients. Results: 365 patients received SLNB during the period of May 1999 to April 2006. A total of 78 patients with neo-adjuvant chemotherapy followed by SLNB were recruited. The SLN identification rate, false-negative rate and accuracy rate were 83.3%, 24.2% and 73.1% respectively. SLNs were identified in 11 (84.6%) of 13 patients with complete clinical response and no false-negative SLN was found. SLNs were found in 54 (83.1%) of 65 patients with partial or no clinical response and false-negative rate was 25%. In the 7 patients with complete pathological response, 6 (85.7%) had SLNs identified with no false-negative node. In the 71 patients with partial or no pathological response, 59 (83.1%) had SLN identified with a false-negative rate of 24.2%. Conclusion: The failed localization and false-negative rates of SLNB after neoadjuvant chemotherapy were unacceptably high in our cohort, concurrent with various published studies. Inaccuracy increases in patients with less than complete clinical or pathological tumor response.