sentinal ln biopsy for breast cancer
DESCRIPTION
Timing of SLN procedure should be performed before or after administration of neoadjuvant chemotherapy? Adune Ratanawichitrasin, MDTRANSCRIPT
Timing of SLN procedure should be performed
before or after
administration of neoadjuvant chemotherapy?
Adune Ratanawichitrasin MD
Axilla staging surgery
Sentinel lymph node biopsy Axillary lymph node dissections
Best for node negative patients
Best for node positive patients
Targeted populations
Node Negative
Node Positive
Stage 0 Stage I Stage II Stage III Stage IV
No need for SLN No need for SLN
Targeted populations
Node Negative
Node Positive
Stage 0 Stage I Stage II Stage III Stage IV
More benefitsMore efforts
Targeted populations
Node Negative
Node Positive
Stage 0 Stage I Stage II Stage III Stage IV
More benefitsMore efforts
Node Negative after neo adjuvant
Neoadjuvant setting
Targeted populations
Node Negative
Node Positive
Stage 0 Stage I Stage II Stage III Stage IV
More benefitsMore efforts
Node Negative after neo adjuvant
Neoadjuvant setting
Node Negative
before neo
adjuvant
Benefit of SLN Bx in neoadjuvant breast cancer patients
•In patients who has negative node or turn
to be negative node after neoadjuvant
•How accurate SLN Bx
After neoadjuvant
Limitation of using SLN Bx in neoadjuvant settings
Before neoadjuvant
or
J.L. Jones et al. / The American Journal of Surgery 190 (2005) 517–520
Before neoadjuvant
Negative nodes 22/52 cases = 42%
1 progressive node during neoadjuvant
Identification rate 100%
After neoadjuvant
Negative 11/36 cases = 31%J.L. Jones et al. / The American Journal of Surgery 190 (2005) 517–520
Identification rate 81% false negative 15%
Success 82-100%
False Negative 11 %
After neoadjuvant
Charfare H. et al. / BJS 2005; 92: 14–23
After neoadjuvant
All 53 patients has positive node before neoadjuvant chemotherapy
Additional 32% node negative cases
Newman EA, et al. / Annals of Surgical Oncology 14(10):2946–2952
The SENTINA study2,234 patients
Design
Neo-adjuvant
Neo-adjuvantThe SENTINA study2,234 patients
Detection rate 99% 60% 80%
The SENTINA study2,234 patients
False negative rate 52% 14%
Neo-adjuvant
The SENTINA study2,234 patients
Neo-adjuvant
Detection rate 60% 80%
False negative rate 52% 14%