Breast Cancer Update for Surgeons, Issue 1, 2017 (Video Program)SLNB after neoadjuvant chemotherapy in patients with node-negative versus node-positive BC
2:19 minutes.
TRANSCRIPTION:
DR LOVE: The other issue is the patient with known axillary disease who’s getting neoadjuvant therapy. How do you approach those patients? Do you still do post-neoadjuvant therapy sentinel node? And if it’s negative, do you not dissect the axilla? DR KHAN: Right. So we try to follow the guidelines that emerged from the Z1071 trial, which was the registry trial of women with biopsy-proven positive nodal disease prior to neoadjuvant who converted to clinically negative axilla and then had sentinel node biopsy. So in that study, the overall false negative rate was almost 13%, 12.5 or so, which is higher than what we are used to seeing in primary surgery. In primary surgery, sentinel nodes, we often have large series now with more experience where the false negative rate is under 5%. So a false negative rate of 13% in the Z1071 trial for the overall trial group of 700 and some women was actually on the high side. But in that trial, the subsets that had acceptable false-positive rates, which were in the realm of what we see with primary surgery, in the 5% to 7% range, those were women who had 2 traces used and who had 3 nodes retrieved. So we try to follow those guidelines so that when — normally, when I’m doing a primary surgery sentinel node, I don’t use 2 traces anymore. I only use the radioactive tracer. But in the neoadjuvant setting, I always use 2 tracers and we always try to go for 3 nodes. DR LOVE: And if it’s negative, using that technique then, you do not do axillary dissection. DR KHAN: Do not dissect the axilla. Correct. DR LOVE: And that includes patients who present with palpable nodes? DR KHAN: Correct. They have to be clinically node-negative with a radiological response. So the neoadjuvant therapy must convert them to clinically node-negative. If they’re still clinically node-positive after neoadjuvant, then they don’t qualify for sentinel node. |