PREDICTIVE VALUE OF NEGATIVE SENTINEL LYMPH NODE BIOPSY AFTER NEO-ADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CANCER

Elkhateeb Kh. O., Abd-Elhamid N. M., and El-Sheshtawy W. H.*

ABSTRACT

Background: Sentinel lymph node biopsy (SLNB) is the standard conservative surgical procedure for axillary management in early breast cancer patients with clinically negative axilla. Achievement of complete response at the axilla after neo-adjuvant chemotherapy (NAC) evolving the use of SLNB in locally advanced breast cancer (LABC). Objectives: Evaluation of the sensitivity, false negative rate and negative predictive value of SLNB in patients with LABC that have clinically negative axilla either before or after NAC. Methods: A prospective study carried out on LABC patients (T3-4, N0-1, and M0) whom received NAC. All cases underwent SLNB using blue dye, followed by axillary lymph node dissection (ALND) along with surgical management of primary tumor. Results: The study included 67 patients, 48 of them turned to clinically negative axilla after NAC (Group A) and 19 had negative axilla before the NAC (Group B), Identification of sentinel lymph node (SLN) was achieved in 46 patients {33 in group A and 13 in group B (p=0.32)}, SLN metastasis has been detected in nine cases, {eight in group A and one in group B (p= 0.03)}, while lymph node metastasis after ALND has been observed in 12 patients {eleven in group A and one in Group B (p= 0.04)}. The sensitivity of SLNB was 80%, 78.6% and 100% for all patients, group A and group B respectively, while the false negative rate was 20%, 21.4% and 0% respectively (p= 0.00). Conclusion: SLNB is a valid treatment option for patients with LABC who have clinically negative axilla at presentation (before NAC), while patients who turned to be clinically negative axilla after NAC; the ALND is still the best treatment option.

Keywords: Sentinel lymph node, Locally advanced breast cancer, Neo-adjuvant chemotherapy.