Breast Cancer Update for Surgeons, Issue 1, 2017 (Video Program)Viewpoint on performing SLNB before the administration of neoadjuvant chemotherapy
2:39 minutes.
TRANSCRIPTION:
DR KHAN: Preneoadjuvant sentinel node biopsy was actually one of the arms that was tested in the SENTINA trial. And they had several arms, and one of the arms the women got a sentinel node prior to neoadjuvant and then a repeat sentinel node following neoadjuvant. And the false negative rate with the repeat sentinel node was 52%. So I don’t think it works to do the sentinel node prior to therapy and then plan to repeat it following therapy. If you do it prior to therapy, then you deprive the patient of the opportunity to avoid axillary dissection if she has a good nodal response. So in that model, the value of a good nodal response, meaning that the patient from clinically node-positive goes to clinically node-negative, it deprives her of the opportunity to avoid axillary dissection. So we have not been using that strategy of 2 sentinel nodes. So if you do the sentinel node prior to neoadjuvant and it’s positive, then I think you commit her to an axillary dissection after neoadjuvant. DR LOVE: Do you typically if you don’t feel anything do any kind of imaging, sonogram, for example, when you're giving neoadjuvant therapy? DR KHAN: Yes. So that’s a pretty controversial area. And we don’t actually have full control of whether a patient gets an axillary ultrasound or not. It’s often been done by the time we see the patient. Or, if the imaging is reviewed by our radiologists and they do additional mammography, they’ll often stick an ultrasound probe on the axilla. So we get that information volitionally or not. If there are abnormal lymph nodes on ultrasounds, and I’m referring the patient for neoadjuvant therapy, that’s pretty much the only situation where I ask for a core biopsy of the abnormal axillary node that’s detected on ultrasound because we hear constantly from our radiation oncologists that that information helps them guide their radiation planning. But doing it that way allows the patient to have the optimal radiation plan but also to avoid axillary dissection if she then has a negative sentinel node following neoadjuvant chemotherapy. |