Henry Mark Kuerer, MD, PhD, FACS

In patients with biopsy-proven, node-positive breast cancer, the false-negative rate was 8.4% with the use of immunohistochemistry.

Neoadjuvant chemotherapy and biologic agents not only can have dramatic effects on primary breast tumors, but they also can eradicate nodal metastases in 30% to 40% of patients overall and in 74% of patients with HER2-positive disease if given concurrently with trastuzumab (Cancer 2010; 116:2884). An ongoing controversy in this setting is whether sentinel lymph node biopsy (SLNB) can be used in place of complete node dissection (CND) to accurately identify patients who achieve pathologic complete response after neoadjuvant chemotherapy.

To address this issue, investigators conducted a prospective, multicenter study of 153 patients with biopsy-proven, node-positive disease (T0–3, N1–2) who underwent both SLNB and CND. An optimal SLNB false-negative rate of ≤10% and an optimal SLNB identification rate of ≥90% were predetermined.

The SLNB false-negative rate was 8.4% with the use of immunohistochemistry and 13.3% without immunohistochemistry. The SNB identification rate was 87.6%.

Citation(s):

Boileau JF et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: The SN FNAC study. J Clin Oncol 2014 Dec 1; [e-pub ahead of print].