Surgical oncology · 2026
The rate of non-sentinel lymph node metastases at axillary dissection in patients with a positive sentinel lymph node after neoadjuvant chemotherapy.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Zaborowski A M, Wehrmann F, McGarry J, Harding T, Balasubramanian I, Spillane C, Nolan L, Eljack W, Quinn E, Corrigan M, Lowery A, Kerin M, Power C, Allen M, Butt A, Hill A D K, Alazawi D, Boyle T, Connolly E, Heeney A, Barry M, Walsh S, Kell M R, Rutherford C, Evoy D, Rothwell J, McCartan D, Boland M R, Prichard R S
Аннотация
BACKGROUND: Axillary lymph node dissection (ALND) remains the standard of care in patients with a positive sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). The aim of this study was to determine the rate of non-sentinel lymph node metastases in patients undergoing completion ALND and to identify factors predictive of positive non-sentinel lymph nodes.
METHODS: A retrospective multicentre study was performed. Patients with node-positive breast cancer who had a positive SLNB after NAC and underwent a completion ALND between 2016 and 2023 were included. Logistic regression analysis was used to identify factors predictive of positive non-sentinel lymph nodes.
RESULTS: A total of 106 patients were included. The median age was 48 (29-74). The median number of sentinel lymph nodes (SLNs) removed was 3 (1-6) and the median number of positive SLNs was 2 (1-4). Forty-five patients (43 %) had additional positive lymph nodes at completion ALND. Additional positive nodes were identified in 53 % of patients with SLN metastases ≤2 mm and in 37 % with SLN metastases >2 mm. Final N stage was ypN1 in 81 patients (76.4 %), ypN2 in 16 (15.1 %) and ypN3 in 9 (8.5 %). ALND increased ypN stage in 20.8 % of patients (22/106). Extra-nodal extension (OR 2.34, C.I 1.06-5.20, p = 0.04) was the only factor associated with a higher likelihood of positive non-sentinel nodes.
CONCLUSION: In patients with a positive SLNB after NAC, 43 % had additional positive nodes. Extranodal extension was predictive of additional nodal disease. ALND increased the ypN stage in 21 %, mostly in patients with hormone-receptor positive and triple negative breast cancer which may have treatment implications.
METHODS: A retrospective multicentre study was performed. Patients with node-positive breast cancer who had a positive SLNB after NAC and underwent a completion ALND between 2016 and 2023 were included. Logistic regression analysis was used to identify factors predictive of positive non-sentinel lymph nodes.
RESULTS: A total of 106 patients were included. The median age was 48 (29-74). The median number of sentinel lymph nodes (SLNs) removed was 3 (1-6) and the median number of positive SLNs was 2 (1-4). Forty-five patients (43 %) had additional positive lymph nodes at completion ALND. Additional positive nodes were identified in 53 % of patients with SLN metastases ≤2 mm and in 37 % with SLN metastases >2 mm. Final N stage was ypN1 in 81 patients (76.4 %), ypN2 in 16 (15.1 %) and ypN3 in 9 (8.5 %). ALND increased ypN stage in 20.8 % of patients (22/106). Extra-nodal extension (OR 2.34, C.I 1.06-5.20, p = 0.04) was the only factor associated with a higher likelihood of positive non-sentinel nodes.
CONCLUSION: In patients with a positive SLNB after NAC, 43 % had additional positive nodes. Extranodal extension was predictive of additional nodal disease. ALND increased the ypN stage in 21 %, mostly in patients with hormone-receptor positive and triple negative breast cancer which may have treatment implications.