Authors: Gaurav Agarwal Sendhil Rajan Sanjay Gambhir Punita Lal Narendra Krishnani Subhash Kheruka
Publish Date: 2015/09/01
Volume: 40, Issue: 7, Pages: 1583-1589
Abstract
Sentinel lymph node biopsy SLNB is the standard of care for staging N0 primary early breast cancers EBC Patients in developing countries mostly present with large LOBC or locally advanced cancers LABC and are treated with neoadjuvant chemotherapy NACT Accuracy of SLNB in staging stage III N0 and postNACT N0 patients is uncertain This prospective validation study on LOBC/LABC patients compared the accuracy of SLNB between primary versus postNACT surgeryFifty T3/T4 N0 patients undergoing primary surgery Group I and 70 LOBC/LABC index stage treated with NACT and N0 at the time of surgery Group II were inducted Validation SLNB was performed using lowcost methyleneblue and 99mTcAntimony colloid SLN identification IR and falsenegative FNR rates were compared between the groups Subgroup analysis was done in Group II per index tumor and nodal stage to identify factors predicting SLN IR and FNR in postNACT patients SLN IR and FNR in both groups were compared with those in previously published SLN validation study and metaanalysis in EBCUsing combination of bluedye and radiocolloid postNACT SLN IR and FNR 829 135 were far inferior to T3/T4 primary surgery group 94 77 p values 0034 0041 and in EBC SLN IR using bluedye alone was dismally low in postNACT LABCs Factors predicting unidentified postNACT SLN and falsenegative SLNB included young age LVI skin infiltration extranodal spread or N2a stage and UOQ tumorsAccuracy of SLNB in T3 N0 tumors undergoing primary surgery is comparable to that of SLNB for N0 EBC In postNACT patients SLNB IR are lower and FNR are higher Factors predictive of nonidentification and falsenegative SLNB include preNACT skin involvement T4b N2a stage or extranodal invasion and LVI and to a lesser extent young age and UOQ location of the tumor
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