Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland.
Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
Br J Surg. 2024 Jan 3;111(1). doi: 10.1093/bjs/znad401.
The necessity of performing a sentinel lymph node biopsy in patients with clinically and radiologically node-negative breast cancer after neoadjuvant chemotherapy has been questioned. The aim of this study was to determine the rate of nodal positivity in these patients and to identify clinicopathological features associated with lymph node metastasis after neoadjuvant chemotherapy (ypN+).
A retrospective multicentre study was performed. Patients with cT1-3 cN0 breast cancer who underwent sentinel lymph node biopsy after neoadjuvant chemotherapy between 2016 and 2021 were included. Negative nodal status was defined as the absence of palpable lymph nodes, and the absence of suspicious nodes on axillary ultrasonography, or the absence of tumour cells on axillary nodal fine needle aspiration or core biopsy.
A total of 371 patients were analysed. Overall, 47 patients (12.7%) had a positive sentinel lymph node biopsy. Nodal positivity was identified in 22 patients (29.0%) with hormone receptor+/human epidermal growth factor receptor 2- tumours, 12 patients (13.8%) with hormone receptor+/human epidermal growth factor receptor 2+ tumours, 3 patients (5.6%) with hormone receptor-/human epidermal growth factor receptor 2+ tumours, and 10 patients (6.5%) with triple-negative breast cancer. Multivariable logistic regression analysis showed that multicentric disease was associated with a higher likelihood of ypN+ (OR 2.66, 95% c.i. 1.18 to 6.01; P = 0.018), whilst a radiological complete response in the breast was associated with a reduced likelihood of ypN+ (OR 0.10, 95% c.i. 0.02 to 0.42; P = 0.002), regardless of molecular subtype. Only 3% of patients who had a radiological complete response in the breast were ypN+. The majority of patients (85%) with a positive sentinel node proceeded to axillary lymph node dissection and 93% had N1 disease.
The rate of sentinel lymph node positivity in patients who achieve a radiological complete response in the breast is exceptionally low for all molecular subtypes.
新辅助化疗后临床和影像学淋巴结阴性的乳腺癌患者行前哨淋巴结活检的必要性受到质疑。本研究旨在确定这些患者的淋巴结阳性率，并确定新辅助化疗后与淋巴结转移相关的临床病理特征（ypN+）。
进行了一项回顾性多中心研究。纳入 2016 年至 2021 年间接受新辅助化疗后行前哨淋巴结活检的 cT1-3 cN0 乳腺癌患者。阴性淋巴结状态定义为无可触及的淋巴结，腋窝超声无可疑淋巴结，或腋窝淋巴结细针抽吸或核心活检无肿瘤细胞。
共分析了 371 例患者。总体而言，47 例（12.7%）前哨淋巴结活检阳性。22 例（29.0%）激素受体+/人表皮生长因子受体 2-肿瘤、12 例（13.8%）激素受体+/人表皮生长因子受体 2+肿瘤、3 例（5.6%）激素受体-/人表皮生长因子受体 2+肿瘤和 10 例（6.5%）三阴性乳腺癌患者存在淋巴结阳性。多变量逻辑回归分析显示，多中心疾病与 ypN+的可能性更高相关（OR 2.66，95%CI 1.18 至 6.01；P = 0.018），而乳房影像学完全缓解与 ypN+的可能性降低相关（OR 0.10，95%CI 0.02 至 0.42；P = 0.002），而与分子亚型无关。仅有 3%的乳房影像学完全缓解患者 ypN+。大多数（85%）前哨淋巴结阳性的患者行腋窝淋巴结清扫术，93%为 N1 疾病。
对于所有分子亚型，乳房影像学完全缓解的患者前哨淋巴结阳性率极低。
