Authors:

Thomas B. Julian, Nilesh Patel, Deborah Dusi, Peter Olson, Girija Nathan, Katherine Jasnosz, and Norman Wolmark.

From the Departments of Human Oncology, Pathology and Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

Supported in part by a grant from Ethicon-Endo Surgery, Inc., Cincinnati, Ohio

Address reprint request to:

Thomas B. Julian, M.D.
Department of Human Oncology
West Penn Allegheny Health System
Allegheny General Hospital
320 East North Avenue
Pittsburgh, PA 15212

Abstract (150 Words)

Sentinel lymph node biopsy is developing into a possible alternative to axillary node dissection and proving to be an accurate method for the detection of micrometastases in lymph nodes of breast cancer patients. Liniited experience exists in the use of sentinel lymph node biopsy in patients who have been treated with neoadjuvant therapy. This study was undertaken to determine the accuracy of sentinel lymph node biopsy in breast cancer patients following neoadjuvant chemotherapy treatment.

The patients with clinical stage I or II breast cancer who received pre-operative doxorubicin/cyclophosphaiflide (AC) chemotherapy or AC/docetaxel (AC-T) were eligible for this study. Lymphatic mapping was carried out intra-operatively with intra-parenchymal injections of Technetium sulfur colloid, blue dye or a combination of both. All patients underwent axillary node dissection. All sentinel nodes were studied with serial step sectioning and H&E staining. Pathologically negative sentinel nodes and axillary nodes were further studied with inimunohistochemistry staining to detect the presence of micrometastases.

Thirty-one breast cancer patients underwent sentinel node biopsy following completion of neoadjuvant chemotherapy from May of 1997 through January of 2001. Lymphatic mapping was performed by radioisotope in two patients (6.5%), blue dye .in one patient (3.2%), and both techniques in 28 patients (90.3%). Sentinel nodes (SN) were identified in 29 of the 31 patients (93.5%). The SN(s) was positive in 11 of 29 patients (38.0%), and was the only positive node(s) in five of those 11 patients (45.5%). By serial step sectioning and H&E staining there were no false negative patients. Immunohistochemistry (IHC) studies were completed on 20 of the 29 SN patients. Ten patients (50%) had H&E positive SN(s) while ten patients (50%) had SN(s) that were negative by H&E staining. None of the ten patients with negative H&E SN(s) had IHC positive nodes. Five of the 19 patients (26.3%) had H&E positive axillary nodes while 14 patients (73.7%) had negative axillary nodes by H&E staining. None of the 14 patients with negative axillary nodes by H&E staining had IHC positive axillary nodes. The sentinel lymph node biopsy truly predicted the status of axillary nodes in 100% of all cases.

Sentinel node identification rate is similar to that obtained in studies evaluating sentinel lymph node biopsy following the diagnosis of breast cancer and prior to any systemic therapy. The sentinel node accurately predicted the status of metastatic disease in the axilla following neoadjuvant therapy. IHC studies failed to detect any additional patients with micrometastases. These results are encouraging and this diagnostic technique may provide treatment guidance in patients who have undergone neoadjuvant therapy and are rendered clinically node negative.

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