Sentinel Lymph Node Biopsy in Breast Cancer Patients With Pathological Complete Response in the Axillary Lymph Node After Neoadjuvant Chemotherapy

김현희; 한재홍; 김선영; 이은숙; 강한성; 이시윤; 정소윤; 이은경

doi:10.4048/jbc.2021.24.e48

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자료유형: 학술저널

저자정보: 김현희 (Department of Surgery Center for Breast Cancer National Cancer Center Goyang Korea.) 한재홍 (국립암센터) 김선영 (Department of Cancer Control and Population Health Graduate School of Cancer Science and Policy Na) 이은숙 (Department of Surgery Center for Breast Cancer National Cancer Center Goyang Korea.) 강한성 (Department of Surgery Center for Breast Cancer National Cancer Center Goyang Korea.) 이시윤 (Department of Surgery Center for Breast Cancer National Cancer Center Goyang Korea.) 정소윤 (Department of Surgery Center for Breast Cancer National Cancer Center Goyang Korea.) 이은경 (Department of Surgery Center for Breast Cancer National Cancer Center Goyang Korea.)

저널정보: 한국유방암학회 Journal of Breast Cancer Journal of Breast Cancer Vol.24 No.6

발행연도: 2021.12

수록면: 531 - 541 (11page)

DOI: 10.4048/jbc.2021.24.e48

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Purpose: Sentinel lymph node biopsy (SLNB) alone following neoadjuvant chemotherapy (NAC) remains controversial in patients with breast cancer who are initially lymph node-positive. The present study aimed to evaluate the impact of SLNB and axillary lymph node dissection (ALND) on breast cancer recurrence and survival in patients who converted from lymph node-positive to pathological node-negative (ypN0) after NAC. Methods: This single-center retrospective study included 223 patients who converted to axillary lymph node-negative status after NAC and underwent breast and axillary surgery between January 2006 and December 2015. This study compared the overall survival (OS), disease-free survival (DFS), ipsilateral axillary lymph node recurrence rates and incidence of postoperative complications, especially, arm lymphedema and shoulder stiffness between SLNB and ALND. Results: This study included 223 patients with axillary pathological complete response (pCR) after NAC and surgery. The SLNB and ALND groups included 94 and 129 patients, respectively. The median follow-up time was 57 (range, 6?155) in the SLNB group and 99 (range 2?159) months in the ALND group. The corresponding 5-year OS and DFS rates were 96.3% and 94.2% (p = 0.392), and 89.2% and 86.4% (p = 0.671), respectively. Four patients (4.3%) in the SLNB group and nine (7.0%) in the ALND group developed locoregional recurrences. Ipsilateral axillary lymph node recurrence and distant metastasis were observed in one (1.1%) and three (2.3%) patients, and in 10 (10.6%) and 11 (8.5%) patients, respectively. Patients in the ALND group were more likely than their SLNB counterparts to experience complications, such as shoulder stiffness (9 [7.0%] vs. 4 [4.3%] patients, p = 0.57). The rate of lymphedema in the ALND group was three times that in the SLNB group (35 [27.1%] vs. 8 [8.5%] patients, p < 0.001). Conclusion: As an alternative to ALND, SLNB has oncological safety in patients with axillary pathological complete response after NAC.

#Breast Neoplasms #Lymphatic Metastasis #Neoadjuvant Therapy #Sentinel Lymph Node Biopsy #Survival Rate

참고문헌 (25)

참고문헌 신청

Alvarado R / 2012 / The role for sentinel lymph node dissection after neoadjuvant chemotherapy in patients who present with node-positive breast cancer / Ann Surg Oncol 19:3177~3184

Koolen BB / 2013 / Early assessment of axillary response with 18F-FDG PET/CT during neoadjuvant chemotherapy in stage II-III breast cancer : implications for surgical management of the axilla / Ann Surg Oncol 20:2227~2235

Straver ME / 2009 / Towards rational axillary treatment in relation to neoadjuvant therapy in breast cancer / Eur J Cancer 45:2284~2292

Rubio IT / 2016 / Sentinel lymph node biopsy after neoadjuvant treatment in breast cancer : work in progress / Eur J Surg Oncol 42:326~332

Dominici LS / 2010 / Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2-positive breast cancer / Cancer 116:2884~2889

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