Evaluation of Sentinel Lymph Node Biopsy After Primary Chemotherapy as Part of De-Escalation of Breast Cancer Treatment

Abstract

Background: Sentinel lymph node biopsy (SLNB) after primary chemotherapy for node-positive breast cancer patients has been gaining popularity as part of the de-escalation of treatment. Aim: The 1ry aim was to assess the surgical outcome of node-positive patients who received primary chemotherapy followed by SLNB. A 2ry aim was to determine the rate of sentinel lymph node identification using the patent blue dye only technique. Methods: A prospective study that included 86 patients with invasive breast cancer and axillary lymph nodes metastasis as proved by ultrasound scan guided core biopsy. Following the completion of primary chemotherapy, sentinel lymph node biopsy was carried out for all patients at the time of breast surgery using the patent blue dye technique. Patients with negative SLNB underwent no further axillary procedure. Completion of axillary lymph node clearance was performed for positive SLNB patients. Results: The sentinel lymph node identification rate using the patent blue dye directed technique was 79%. Sixtyseven (78%) patients underwent wide local excision, and 35% did not need completion of axillary lymph node clearance due to downstaging following primary chemotherapy. Conclusions: Sentinel lymph node biopsy following primary chemotherapy for invasive breast cancer appears to be a safe, reliable technique, with an acceptable identification rate, even when using the patent blue dye technique only.