Optimization of axillary staging in breast cancer: Efficacy of sentinel lymph node biopsy and targeted axillary dissection post-chemotherapy.

PURPOSE: To evaluate the contribution of sentinel node biopsy using lymphoscintigraphy in breast cancer (BC) with clip-marked lymph node involvement and neoadjuvant chemotherapy (NACT) in axillary staging and reduction of potential false negatives from exclusively radiological localization.

MATERIAL AND

METHODS

A retrospective study of 20 women with BC and nodal involvement marked with clip and NACT. Lymphoscintigraphy was complemented with SPECT/CT in 12 patients. The correlation between lymphoscintigraphic sentinel lymph node (SLN) and the clip-marked node was analyzed.

RESULTS

Lymphoscintigraphy detected 34 axillary SLNs. SPECT/CT showed uptake in 10 of 16 clip-marked nodes (62.5%). During surgery, 39 nodes were removed; 33 (84.6%) were SLNs, 18 with clip, and 15 without clip. One SLN was not located surgically. Six clip-marked nodes (15.3%) showed no uptake. In 8 of 20 patients (40%), drainage to a single SLN was detected; this corresponded to the clip-marked node in 5 cases (non-metastatic) and non-clip-marked nodes in 3 cases (1 metastatic). In 12 of 20 patients (60%), lymphoscintigraphy showed drainage to more than one SLN. A total of 26 SLNs were detected: 13 SLNs with clip (5 metastatic) and 13 without clip (4 metastatic). Lymphoscintigraphy detected 5 SLNs in 4 of 20 patients (20%) that did not match the clip-marked node and were metastatic. The detection and removal rate of GCL was 97% and false negative rate was 16,67%.

CONCLUSION

Lymphoscintigraphy in BC with positive axilla before NACT detected metastases in a significant percentage of patients not identified with clip, being an essential tool for accurate axillary staging.