Recently minimum axillary surgery has been indicated due to its morbidity. Since the report of Z011, there is a change in axillary management, and even if metastasis is proven in Sentinel node biopsy (SNB), the patients whose axillary dissection is omitted are increasing. If a patient who SNB is unnecessary can be found before surgery, it can be possible to treat the patient more generously. We retrospectively reviewed the patients in which neo adjuvant chemotherapy (NAC) was performed with clinically N0 (cN0) and SNB was performed, and examined clinicopathological factors whether we can find patients who do not need even SNB biopsy.
A retrospective cohort study of cN0 breast cancer patients before NAC and who underwent breast surgery was conducted, investigating 199 consecutive patients between 2009 and 2015 in our hospital. Institutional review board approved this retrospective study. Between the patients with or without nodal metastasis in SNB after NAC, we compared the differences in clinicopathological factors including Estrogen Receptor (ER), Progesterone Receptor (PgR), human epidermal growth factor receptor 2 (HER2), nuclear grade(NG), Ki-67 in needle biopsy specimens, and tumor size before NAC, and complete response on MRI (MRI-CR) after NAC. We defined MRI-CR as no residual enhancement, or non-invasive faint and indistinct enhancement.
Of the 199 patients, 184 patients (92%) were pathological node negative and 15 patients (8%) are node positive after NAC. In univariate analysis, patients achieved MRI-CR (p < 0.01), with high NG (p = 0.04), without PgR expression (p = 0.04) and high Ki-67 were significantly correlated node negative in SNB. In multivariate analysis, the patients with MRI-CR (p < 0.01, HR 10.716) and high Ki-67 (p < 0.01, HR 7.577) were significantly correlated node negative in SNB. In ER negative and HER2 positive type no lymph node metastasis was found (0/26 patients).
Detection of MRI-CR in patient with cN0 before NAC correlate no nodal metastasis in SNB. In such patient, there is a possibility that SNB might be omitted in the future.
St Luke\'s International Hospital
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All authors have declared no conflicts of interest.