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Sentinel Lymph Node Biopsy Useful After Neoadjuvant Chemotherapy

Sentinel Lymph Node Biopsy Useful After Neoadjuvant Chemotherapy

ORLANDO—The concept of sentinel lymph node biopsy as an alternative to
axillary node dissection appears to be applicable and useful in breast cancer
patients after neoadjuvant chemotherapy, according to an analysis from protocol
B-27 of the National Surgical Adjuvant Breast and Bowel Project (NSABP),
presented at the 38th Annual Meeting of the American Society of Clinical
Oncology (abstract 140).

These results are comparable to those obtained from studies evaluating
sentinel node biopsy before systemic therapy and therefore provide
encouragement that this procedure can be applied earlier in the management
process, the NSABP investigators noted.

The results from the primary analysis of B-27 were reported at the 2001 San
Antonio Breast Cancer Symposium. At ASCO, Terry Mamounas, MD, MPH, presented an
updated analysis that linked tumor response data to sentinel node biopsy
results. Dr. Mamounas is associate professor of surgery, Northeastern Ohio
University College of Medicine, Canton.

NSABP B-27 evaluated neoadjuvant Adriamycin/cyclophosphamide (AC) (60/600
mg/m² every 3 weeks) plus docetaxel (Taxotere) (100 mg/m² every 3 weeks) in
2,411 patients with large operable tumors. Patients were randomized to four
cycles of AC followed by surgery, four cycles of AC followed by four cycles of
docetaxel and then surgery, or four cycles of AC, then surgery, followed by
four cycles of docetaxel.

Dr. Mamounas reported on a subset of 428 patients who underwent sentinel
node biopsy off protocol at the discretion of their physicians. At least one
sentinel node was identified and removed in 363 of these patients, for an 85%
identification rate. Identification was not related to the year the procedure
was performed, or the age, tumor size, or nodal status of the patient, and was
most successful when radioisotope was used.

In 343 patients, both sentinel node biopsy and axillary nodal dissections
were performed, providing an opportunity to assess the effectiveness of
sentinel node biopsy after neoadjuvant therapy.

The sentinel node was positive in 125 patients, and it was the only positive
node in 70 patients (56%), Dr. Mamounas said. The sentinel node was negative in
218 patients, and it was falsely negative in 15 of 140 node-positive patients
(11%) or 4% of all patients (15 of 343).

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