SENTINEL LYMPH NODE BIOPSY AFTER NEOADJUVANT CHEMOTHERAPY IN CLINICALLY NODE POSITIVE AXILLA OF BREAST CANCER

Background: In the modern treatment of breast cancer, the Sentinel Lymph node biopsy indication is present in many clinical circumstances, instead of classical axillary lymphadenectomy. It presents the advantage of conservative surgery, which significantly decreases the rate of postoperative complications, offering the patients a better quality of Life and reducing the costs of patients care after surgery. Sentinel Lymph node biopsy (SLNB) vs. axillary Lymph node dissection (ALND) in the current surgical treatment of early stage breast cancer.
Aim of the Work: The aim of the present study is to evaluate staging the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy in previous clinically node positive axilla in breast cancer to avoid the morbidity of an ALND.
Patients and Methods: This was a prospective cohort study was held in El Demerdash hospital Ain Shams University hospitals, Cairo, Egypt started with one hundred and twenty female patients with clinically node positive axilla in breast cancer. Approval of the Ethical Committee and written informed consent from all participants were obtained. Patient selection was achieved through a number of inclusion and exclusion criteria.
Results: Our study showed that SLNB is acceptable in cN1/2 patients who become cN0 after neoadjuvant therapy: particularly in those with no residual disease in the breast, because SN status maintains its expected prognostic role, but also in cases with residual disease, because Axillary dissection (AD) has no influence on outcomes.
Conclusion: Sentinel lymph node biopsy will replace axillary lymph node dissection (ALND) in those patients with clinically node positive axilla without compromising their oncologic outcomes. Especially, rates of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) have increased. In the neoadjuvant setting, SLN after NAC is feasible and accurate in clinically node positive patients as a continuous effort to avoid the morbidity of ALND.