WASHINGTONSentinel lymph node (SLN) biopsy, which is
"evolving as a possible alternative" to complete axillary node
dissection in breast cancer, can be performed as successfully in patients who
have received neoadjuvant chemotherapy as in patients who have not, said
Eleftherios Mamounas, MD, of Aultman Cancer Center, Canton, Ohio, and the
National Surgical Adjuvant Breast and Bowel Project (NSABP).
Neoadjuvant chemotherapy is often used before surgery to downstage breast
cancers to permit lumpectomy rather than mastectomy, Dr. Mamounas said in his
presentation at the 54th Annual Cancer Symposium of the Society of Surgical
Oncology (plenary session III).
Although randomized comparisons of the two methods of axillary staging are
currently underway, little was known about the usefulness of SLN biopsy after
neoadjuvant chemotherapy. A number of small studies have yielded varying
success rates and false-negative rates.
It was not known, for example, whether neoadjuvant chemotherapy affects
lymphatic drainage and thus makes SLN biopsy more difficult, Dr. Mamounas
He reported an analysis of data from NSABP B-27 that explored these
questions. Patients in this trial received neoadjuvant chemotherapy before
either lumpectomy and axillary lymph node dissection or modified radical
During the trial, some participating surgeons also performed SLN biopsy
before doing axillary node dissection. This afforded an opportunity to study
SLN biopsy in conjunction with neoadjuvant chemotherapy.
Of the 1,936 patients randomized from 1996 through 1999, 1,832 had complete
surgical information available, and 325 of these patients had lymphatic mapping
with an attempt at SLN biopsy before axillary node dissection.