Sentinel Lymph Node Biopsy After Neoadjuvant Therapy Shows Promise in Node-Positive Breast Cancer Patients

A recent study conducted by Marina Alarcón and colleagues at the Hospital de Sagunto and Hospital Clínico Universitario de Valencia, Spain, has shed light on the effectiveness of sentinel lymph node biopsy (SLNB) after neoadjuvant therapy (NAT) in node-positive (N+) breast cancer patients. The research, published in the journal Surgeon, aimed to assess the accuracy of SLNB following NAT and the efficacy of wire localization of the clipped node to enhance results.

Material and Methods: The study involved a cross-sectional diagnostic technique validation in N+ patients who underwent NAT. The affected lymph node was clipped at diagnosis, and SLNB along with axillary lymph node dissection (ALND) were performed in cases showing clinical-radiological lymph node response post-NAT. Wire localization of the clipped node was added to improve the accuracy of the procedure.

Results: Out of 103 patients included in the study, with a mean age of 54.4 years, wire marking was performed in 28 cases. The overall identification rate (IR) of SLN was 81.6%, with a median of 2 nodes removed. The study reported an overall false negative rate (FNR) of 6.1%, with sensitivity and overall accuracy rates of 93.9% and 95.2%, respectively. Notably, in the group where both clip and wire localization were used, the FNR decreased to 0%, achieving 100% accuracy. Axillary pathologic complete response was observed in 24.3% of cases.

Conclusions: The findings suggest that SLNB is a useful technique for node-positive patients at diagnosis who respond to NAT. The addition of preoperative wire localization of the biopsied lymph node significantly reduces the FNR without increasing the number of complications, offering a promising approach for the management of node-positive breast cancer patients post-NAT.