SLN surgery helps to identify nodal status in breast cancer patients

Sentinel lymph node (SLN) surgery after chemotherapy has identified nodal status after treatment with neoadjuvant chemotherapy in 84 per cent of node-positive breast cancer patients.

This is according to a study led by Judy C Boughey, managing director of the Mayo Clinic in Rochester, Minnesota.

Many women with breast cancer that has spread to their lymph nodes are put through axillary lymph node dissection (ANLD), but neoadjuvant chemotherapy can eliminate disease in some patients' lymph nodes, putting them in a node-negative status.

SLN surgery is often used to treat petients with initially diagnosed node-negative disease, but this latest research looked into using the technology for those with node-positive breast cancer who are put through neoadjuvant chemotherapy, potentially helping profesionals to prep new treatments.

"The question arises as to whether removal of the lymph nodes with an ALND is needed, or whether less invasive surgery, with a sampling of the nodes by SLN surgery alone, would reliably identify which patients still have disease in the lymph nodes and which patients have negative lymph node," Ms Boughey stated.

Researchers carried out a multicentre study of 756 women with node-positive breast cancer who received neoadjuvant chemotherapy and underwent surgery.

Of these, 637 underwent both SLN surgery with indetification and removal of the sentinel nodes under the arm, while ALND was utilised to take out the majority of the lymph nodes in the axilla.

Nodal status was identified by SLN surgery in 91 per cent of the patients.

"If SLN surgery is accurate for evaluating the lymph nodes after neoadjuvant chemotherapy, it potentially could allow patients to avoid ALND and undergo SLN for axillary staging and only require an ALND if the SLN is positive.

"This rate is lower with use of dual tracer (blue dye and radiolabelled colloid) to identify the SLN, and the false-negative rate is lower the more SLNs are removed. Therefore, technical factors are important to minimize incorrect nodal staging," Ms Boughey explained.