Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
Breast Unit - AOUP Paolo Giaccone Palermo, Palermo, Italy.
Anticancer Res. 2024 May;44(5):2047-2053. doi: 10.21873/anticanres.17008.
BACKGROUND/AIM: Sentinel lymph node biopsy (SLNB) is effective in patients with breast cancer (BC) and positive axillary lymph nodes undergoing neoadjuvant chemotherapy (NAC). However, the frequency with which axillary lymphadenectomy (ALND) can be avoided remains debated. This study aimed to identify patient populations that can benefit from this approach.
The data of 195 consecutive patients with BC and positive axillary lymph nodes at diagnosis who underwent NAC were retrospectively analyzed. In all cases, the positivity of the lymph nodes was confirmed by cytological examination. Patients converted to ycN0 after NAC were considered eligible for SLNB. Indications for ALND were failed mapping, fewer than three SLNs recovered, and positive SLNs.
Of 195 cN1 patients potentially eligible for SLNB, 71 (36.4%) remained clinically ycN+ after NAC and underwent elective ALND, while 124 (83.7%) converted to ycN0 after NAC and SLNB. The lymph node identification rate was 95.9% (119/124 patients) with three or more SLNs recovered in 83 cases (89.8%). One or two lymph nodes were recovered in 36 cases (30.2%). Nodal pathologic complete response (pCR) was found in 34/83 (40.9%) patients with three or more SLNs recovered. Considering all 195 patients initially included in the study, 55 patients (28.2%) achieved lymph node pCR after NAC. Nodal pCR varied based on hormone receptor and HER2 status, with rates ranging from 20.7% for ER+/- patients to 95.3% for -/HER2+ patients (p<0.001).
More than 80% of cN1 patients in our study were eligible for SLNB after NAC. ALND could be avoided in approximately 30% of cases, supporting the role of NAC in reducing the need for ALND among patients with lymph node metastases.
背景/目的：前哨淋巴结活检（SLNB）对于接受新辅助化疗（NAC）的乳腺癌（BC）伴阳性腋窝淋巴结的患者是有效的。然而，仍然存在关于可以避免腋窝淋巴结清扫术（ALND）的频率的争议。本研究旨在确定可以从这种方法中受益的患者人群。
回顾性分析了 195 例连续诊断为 BC 且腋窝淋巴结阳性的患者的数据，这些患者均接受了 NAC。所有病例均通过细胞学检查证实了淋巴结的阳性。NAC 后转为 ycN0 的患者被认为有资格接受 SLNB。ALND 的适应证为：示踪失败、恢复的 SLN 少于 3 个和 SLN 阳性。
在 195 例有 SLNB 适应证的 cN1 患者中，有 71 例（36.4%）在 NAC 后仍为临床 ycN+，需要进行选择性 ALND，而 124 例（83.7%）在 NAC 后转为 ycN0 并接受了 SLNB。124 例患者中有 119 例（95.9%）淋巴结识别率为 95.9%（119/124 例），其中 83 例（89.8%）恢复了 3 个或更多的 SLN。36 例（30.2%）恢复了 1 或 2 个淋巴结。在恢复了 3 个或更多 SLN 的 34 例患者（40.9%）中发现了淋巴结病理完全缓解（pCR）。考虑到最初纳入研究的 195 例患者，55 例（28.2%）在 NAC 后达到了淋巴结 pCR。淋巴结 pCR 基于激素受体和 HER2 状态而有所不同，在恢复了 3 个或更多 SLN 的患者中，ER+/HER2-患者的 pCR 率为 20.7%，而 ER-/HER2+患者的 pCR 率为 95.3%（p<0.001）。
在我们的研究中，超过 80%的 cN1 患者在 NAC 后有接受 SLNB 的适应证。在大约 30%的病例中可以避免 ALND，支持 NAC 在减少淋巴结转移患者中 ALND 的需求方面的作用。
