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Sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer with initially cytologically confirmed negative axillary lymph nodes. A review

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ABSTRACT

Introduction. Performing the sentinel lymph node (SLN) biopsy remains the gold standard method to stage the axilla in breast cancer (BC) patients. For women with breast tumors who have an indication for neoadjuvant chemotherapy (NAC) (either locally ad- vanced BC or early-stage BC with unfavorable prognos- tic factors- Her-2/ neu positive or triple negative BC) and without initial involvement of the lymph nodes (LNs), the SLN biopsy is generally applied before the NAC. However, many studies as well as the data pre- sented at the San Antonio Breast Cancer Symposium 2016 demonstrated that SLN after NAC in women with initially negative nodes is safe with a low rate of recurrence.

The objective of this review is to present the argu- ment for performing the SLN excision after NAC in women with initially clinically negative LNs before.

Method. We performed a research on Pubmed for studies which included the evaluation of the SLNs after NAC and focused our paper on the identifica- tion rate (IR) of the sentinel LNs, false-negative rate (FNR) of the status of the sentinel LNs as well as the recurrence rate of the disease when SLB has been per- formed after NACT. The used key words were: „breast cancer“, „neoadjuvant chemotherapy“, „sentinel lymph node“ and „pathologic complete response“.

Conclusion. The reported IR and FNR of the SLN concept performed after NAC as well as the dis- ease-free and overall survival rate observed after a pe- riod of follow-up are arguments to support the idea the SLN biopsy can be safely performed after the comple- tion of the NAC in a single procedure together with the breast operation, with the essential condition that the axillary LNs are (cytologically confirmed) negative at the initial examination prior to pursue to the initi- ation of the NAC.

Key words: breast cancer, sentinel lymph node, neo- adjuvant chemotherapy.

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Nicolae Bacalbasa, Olivia Ionescu, Mihai Dimitriu and Cristian Balalau

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