Swedish prospective multicenter trial on the accuracy and clinical relevance of sentinel lymph node biopsy before neoadjuvant systemic therapy in breast cancer
Identifieur interne : 000140 ( Main/Exploration ); précédent : 000139; suivant : 000141Swedish prospective multicenter trial on the accuracy and clinical relevance of sentinel lymph node biopsy before neoadjuvant systemic therapy in breast cancer
Auteurs : Linda Zetterlund [Suède] ; Fuat Celebioglu [Suède] ; Rimma Axelsson [Suède] ; Jana De Boniface [Suède] ; Jan Frisell [Suède]Source :
- Breast Cancer Research and Treatment [ 0167-6806 ] ; 2017.
Abstract
The timing of sentinel lymph node biopsy (SLNB) in the context of neoadjuvant systemic therapy (NAST) in breast cancer is still controversial. SLNB before NAST has been evaluated in few single-institution studies in which axillary lymph node dissection (ALND), however, was commonly not performed in case of a negative SLNB. We investigated the potential clinical relevance of SLNB before NAST by performing ALND in all patients after NAST.
This national multicenter trial prospectively enrolled clinically node-negative breast cancer patients planned for NAST at 13 recruiting Swedish hospitals between October 2010 and December 2015. SLNB before NAST was followed by ALND after NAST in all individuals. Repeat SLNB after NAST was encouraged but not mandatory.
SLNB before NAST was performed in 224 patients. The identification rate was 100% (224/224). The proportion of patients with a negative SLNB before NAST but positive axillary lymph nodes after NAST was 7.4% (nine of 121 patients, 95% CI 4.0–13.5). Among those with a positive SLNB before NAST, 23.2% (86/112) had further positive lymph nodes after NAST.
In clinically node-negative patients, SLNB before NAST is highly reliable. With this sequence, ALND and regional radiotherapy can be safely omitted in patients with a negative SLNB provided good clinical response to NAST. Additionally, SLNB-positive patients upfront will receive correct nodal staging unaffected by NAST and be consequently offered adjuvant locoregional treatment according to current guidelines pending the results of ongoing randomized trials.
Url:
DOI: 10.1007/s10549-017-4163-2
PubMed: 28213781
PubMed Central: 5387013
Affiliations:
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Karolinska Institutet, Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.416648.9</institution-id><institution>Department of Surgery,</institution><institution>Södersjukhuset,</institution></institution-wrap>Stockholm, 118 83 Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Stockholm</wicri:regionArea></affiliation></author><author><name sortKey="Celebioglu, Fuat" sort="Celebioglu, Fuat" uniqKey="Celebioglu F" first="Fuat" last="Celebioglu">Fuat Celebioglu</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.416648.9</institution-id><institution>Department of Surgery,</institution><institution>Södersjukhuset,</institution></institution-wrap>Stockholm, 118 83 Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Stockholm</wicri:regionArea></affiliation></author><author><name sortKey="Axelsson, Rimma" sort="Axelsson, Rimma" uniqKey="Axelsson R" first="Rimma" last="Axelsson">Rimma Axelsson</name><affiliation wicri:level="1"><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.4714.6</institution-id><institution>Department of Clinical Science, Intervention and Technology, Division of Radiography,</institution><institution>Karolinska Institutet,</institution></institution-wrap>Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Stockholm</wicri:regionArea></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="GRID">grid.24381.3c</institution-id><institution>Department of Radiology,</institution><institution>Karolinska University Hospital,</institution></institution-wrap>Huddinge, Stockholm, 141 86 Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Huddinge, Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation></author><author><name sortKey="De Boniface, Jana" sort="De Boniface, Jana" uniqKey="De Boniface J" first="Jana" last="De Boniface">Jana De Boniface</name><affiliation wicri:level="1"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="GRID">grid.4714.6</institution-id><institution>Department of Molecular Medicine and Surgery,</institution><institution>Karolinska Institutet,</institution></institution-wrap>Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Stockholm</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="GRID">grid.440104.5</institution-id><institution>Department of Surgery,</institution><institution>Capio St Göran’s Hospital,</institution></institution-wrap>Stockholm, 112 81 Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Stockholm</wicri:regionArea></affiliation></author><author><name sortKey="Frisell, Jan" sort="Frisell, Jan" uniqKey="Frisell J" first="Jan" last="Frisell">Jan Frisell</name><affiliation wicri:level="1"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="GRID">grid.4714.6</institution-id><institution>Department of Molecular Medicine and Surgery,</institution><institution>Karolinska Institutet,</institution></institution-wrap>Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Stockholm</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="GRID">grid.24381.3c</institution-id><institution>Department of Breast and Endocrine Surgery,</institution><institution>Karolinska University Hospital,</institution></institution-wrap>Solna, 171 76 Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Solna</wicri:regionArea></affiliation></author></analytic><series><title level="j">Breast Cancer Research and Treatment</title><idno type="ISSN">0167-6806</idno><idno type="eISSN">1573-7217</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>The timing of sentinel lymph node biopsy (SLNB) in the context of neoadjuvant systemic therapy (NAST) in breast cancer is still controversial. SLNB before NAST has been evaluated in few single-institution studies in which axillary lymph node dissection (ALND), however, was commonly not performed in case of a negative SLNB. We investigated the potential clinical relevance of SLNB before NAST by performing ALND in all patients after NAST.</p></sec><sec><title>Methods</title><p>This national multicenter trial prospectively enrolled clinically node-negative breast cancer patients planned for NAST at 13 recruiting Swedish hospitals between October 2010 and December 2015. SLNB before NAST was followed by ALND after NAST in all individuals. Repeat SLNB after NAST was encouraged but not mandatory.</p></sec><sec><title>Results</title><p>SLNB before NAST was performed in 224 patients. The identification rate was 100% (224/224). The proportion of patients with a negative SLNB before NAST but positive axillary lymph nodes after NAST was 7.4% (nine of 121 patients, 95% CI 4.0–13.5). Among those with a positive SLNB before NAST, 23.2% (86/112) had further positive lymph nodes after NAST.</p></sec><sec><title>Conclusions</title><p>In clinically node-negative patients, SLNB before NAST is highly reliable. With this sequence, ALND and regional radiotherapy can be safely omitted in patients with a negative SLNB provided good clinical response to NAST. Additionally, SLNB-positive patients upfront will receive correct nodal staging unaffected by NAST and be consequently offered adjuvant locoregional treatment according to current guidelines pending the results of ongoing randomized trials.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Krag, Dn" uniqKey="Krag D">DN Krag</name></author><author><name sortKey="Anderson, Sj" uniqKey="Anderson S">SJ Anderson</name></author><author><name sortKey="Julian, Tb" uniqKey="Julian T">TB Julian</name></author><author><name sortKey="Brown, Am" uniqKey="Brown A">AM Brown</name></author><author><name sortKey="Harlow, Sp" uniqKey="Harlow S">SP Harlow</name></author><author><name sortKey="Costantino, Jp" uniqKey="Costantino J">JP Costantino</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schule, J" uniqKey="Schule J">J Schule</name></author><author><name sortKey="Frisell, J" uniqKey="Frisell J">J 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uniqKey="Cole B">BF Cole</name></author><author><name sortKey="Zurrida, S" uniqKey="Zurrida S">S Zurrida</name></author><author><name sortKey="Viale, G" uniqKey="Viale G">G Viale</name></author><author><name sortKey="Luini, A" uniqKey="Luini A">A Luini</name></author><author><name sortKey="Veronesi, P" uniqKey="Veronesi P">P Veronesi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Giuliano, Ae" uniqKey="Giuliano A">AE Giuliano</name></author><author><name sortKey="Ballman, K" uniqKey="Ballman K">K Ballman</name></author><author><name sortKey="Mccall, L" uniqKey="Mccall L">L McCall</name></author><author><name sortKey="Beitsch, P" uniqKey="Beitsch P">P Beitsch</name></author><author><name sortKey="Whitworth, Pw" uniqKey="Whitworth P">PW Whitworth</name></author><author><name sortKey="Blumencranz, P" uniqKey="Blumencranz P">P Blumencranz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chapman, Ch" uniqKey="Chapman C">CH Chapman</name></author><author><name sortKey="Jagsi, R" uniqKey="Jagsi R">R Jagsi</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Suède</li></country><region><li>Svealand</li></region><settlement><li>Stockholm</li></settlement></list><tree><country name="Suède"><region name="Svealand"><name sortKey="Zetterlund, Linda" sort="Zetterlund, Linda" uniqKey="Zetterlund L" first="Linda" last="Zetterlund">Linda Zetterlund</name></region><name sortKey="Axelsson, Rimma" sort="Axelsson, Rimma" uniqKey="Axelsson R" first="Rimma" last="Axelsson">Rimma Axelsson</name><name sortKey="Axelsson, Rimma" sort="Axelsson, Rimma" uniqKey="Axelsson R" first="Rimma" last="Axelsson">Rimma Axelsson</name><name sortKey="Celebioglu, Fuat" sort="Celebioglu, Fuat" uniqKey="Celebioglu F" first="Fuat" last="Celebioglu">Fuat Celebioglu</name><name sortKey="Celebioglu, Fuat" sort="Celebioglu, Fuat" uniqKey="Celebioglu F" first="Fuat" last="Celebioglu">Fuat Celebioglu</name><name sortKey="De Boniface, Jana" sort="De Boniface, Jana" uniqKey="De Boniface J" first="Jana" last="De Boniface">Jana De Boniface</name><name sortKey="De Boniface, Jana" sort="De Boniface, Jana" uniqKey="De Boniface J" first="Jana" last="De Boniface">Jana De Boniface</name><name sortKey="Frisell, Jan" sort="Frisell, Jan" uniqKey="Frisell J" first="Jan" last="Frisell">Jan Frisell</name><name sortKey="Frisell, Jan" sort="Frisell, Jan" uniqKey="Frisell J" first="Jan" last="Frisell">Jan Frisell</name><name sortKey="Zetterlund, Linda" sort="Zetterlund, Linda" uniqKey="Zetterlund L" first="Linda" last="Zetterlund">Linda Zetterlund</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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