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Title: Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction

Abstract

Background: Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer. Methods: All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between 2010 and 2016 were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN. Results: In total 788 patients were included, of whom 25.0% (197/788) had positive SLN. cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+ , and cT1-2N0 triple-negative patients had the lowest rate of positive SLN: 7.2–11.5%, 0–6.3%, and 2.9–6.2%, respectively. cT1-3N0 ER+HER2− and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8–41.7% and 30.4%, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.01–3.96), cT3 (OR 2.56; 95% CI 1.30–5.38), grade 3 (OR 0.44; 95% CI 0.21–0.91), and ER+HER2− subtype (OR 3.94; 95% CI 1.77–8.74) were correlated with positive SLN. Conclusions: In cT1-3N0 ER+HER2+,more » cT1-3N0 ER−HER2+, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER+HER2− and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.« less

Authors:
 [1];  [2];  [1];  [3];  [1];  [3];  [4];  [1]
  1. Maastricht University Medical Center+, Department of Surgery (Netherlands)
  2. Maastricht University Medical Center+, GROW – School for Oncology and Developmental Biology (Netherlands)
  3. Netherlands Comprehensive Cancer Organization, Department of Research (Netherlands)
  4. Maastricht University Medical Center+, Department of Radiology and Nuclear Medicine (Netherlands)
Publication Date:
OSTI Identifier:
22927538
Resource Type:
Journal Article
Journal Name:
Annals of Surgical Oncology (Online)
Additional Journal Information:
Journal Volume: 26; Journal Issue: 12; Other Information: Copyright (c) 2019 Society of Surgical Oncology; Article Copyright (c) 2019 The Author(s); Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 1534-4681
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; DECISION MAKING; LYMPH NODES; MAMMARY GLANDS; NEOPLASMS; PATIENTS; RADIOTHERAPY; REGRESSION ANALYSIS

Citation Formats

Samiei, S., E-mail: sanaz.samiei@mumc.nl, Kaathoven, B. N. van, Boersma, L., Granzier, R. W. Y., Siesling, S., Engelen, S. M. E., Munck, L. de, Kuijk, S. M. J. van, Hulst, R. R. J. W. van der, Lobbes, M. B. I., Smidt, M. L., and Nijnatten, T. J. A. van. Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction. United States: N. p., 2019. Web. doi:10.1245/S10434-019-07643-X.
Samiei, S., E-mail: sanaz.samiei@mumc.nl, Kaathoven, B. N. van, Boersma, L., Granzier, R. W. Y., Siesling, S., Engelen, S. M. E., Munck, L. de, Kuijk, S. M. J. van, Hulst, R. R. J. W. van der, Lobbes, M. B. I., Smidt, M. L., & Nijnatten, T. J. A. van. Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction. United States. https://doi.org/10.1245/S10434-019-07643-X
Samiei, S., E-mail: sanaz.samiei@mumc.nl, Kaathoven, B. N. van, Boersma, L., Granzier, R. W. Y., Siesling, S., Engelen, S. M. E., Munck, L. de, Kuijk, S. M. J. van, Hulst, R. R. J. W. van der, Lobbes, M. B. I., Smidt, M. L., and Nijnatten, T. J. A. van. 2019. "Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction". United States. https://doi.org/10.1245/S10434-019-07643-X.
@article{osti_22927538,
title = {Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction},
author = {Samiei, S., E-mail: sanaz.samiei@mumc.nl and Kaathoven, B. N. van and Boersma, L. and Granzier, R. W. Y. and Siesling, S. and Engelen, S. M. E. and Munck, L. de and Kuijk, S. M. J. van and Hulst, R. R. J. W. van der and Lobbes, M. B. I. and Smidt, M. L. and Nijnatten, T. J. A. van},
abstractNote = {Background: Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer. Methods: All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between 2010 and 2016 were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN. Results: In total 788 patients were included, of whom 25.0% (197/788) had positive SLN. cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+ , and cT1-2N0 triple-negative patients had the lowest rate of positive SLN: 7.2–11.5%, 0–6.3%, and 2.9–6.2%, respectively. cT1-3N0 ER+HER2− and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8–41.7% and 30.4%, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.01–3.96), cT3 (OR 2.56; 95% CI 1.30–5.38), grade 3 (OR 0.44; 95% CI 0.21–0.91), and ER+HER2− subtype (OR 3.94; 95% CI 1.77–8.74) were correlated with positive SLN. Conclusions: In cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER+HER2− and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.},
doi = {10.1245/S10434-019-07643-X},
url = {https://www.osti.gov/biblio/22927538}, journal = {Annals of Surgical Oncology (Online)},
issn = {1534-4681},
number = 12,
volume = 26,
place = {United States},
year = {2019},
month = {11}
}