Skip to main content
SpringerLink
Log in

Analysis of sentinel lymph node mapping with immediate pathologic review in patients receiving preoperative chemotherapy for breast carcinoma

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node mapping (SLNM) and neoadjuvant chemotherapy are becoming established components of therapy for selected patients with breast carcinoma. However, neoadjuvant therapy has been considered a relative contraindication to SLNM. In an effort to learn whether patients who have received preoperative chemotherapy can undergo accurate SLNM, we evaluated our experience with this technique.

Methods

From January 1997 to June 2000, SLNM and axillary lymph node dissection were concurrently performed in 35 patients who received preoperative chemotherapy. Mapping was performed with99mTc sulfur colloid only in one patient and Lymphazurin dye only in 15 patients, and the two methods were combined in the remainder.

Results

SLNM successfully identified a sentinel lymph node in 30 (86%) patients. Metastatic disease was identified in the sentinel lymph nodes of four patients during surgery. The intraoperative pathologic diagnosis proved to be correct in 19 (79%) of 24 patients. The final pathologic diagnosis of the sentinel lymph node reflected the status of the axillary contents in all patients in whom it was identified.

Conclusions

These results demonstrate that SLNM can be consistently performed in patients receiving preoperative chemotherapy for breast cancer, suggesting the utility of this technique in this patient populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma.Arch Surg 1992;127:392–9.

    PubMed  CAS  Google Scholar 

  2. Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe.Surg Oncol 1993;2:335–59.

    Article  PubMed  CAS  Google Scholar 

  3. Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and SLNB in the patient with breast cancer.JAMA 1996;276:1818–22.

    Article  PubMed  CAS  Google Scholar 

  4. Schrenk P, Rieger R, Shamiyeh A, Wayand W. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma.Cancer 2000;88:608–14.

    Article  PubMed  CAS  Google Scholar 

  5. Turner RR, Ollila DW, Krasne DL, Giuliano AE. Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma.Ann Surg 1997;226:271–6; discussion, 276–8.

    Article  PubMed  CAS  Google Scholar 

  6. Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL. Improved axillary staging of breast cancer with sentinel lymphadenectomy.Ann Surg 1995;222:394–401.

    Article  PubMed  CAS  Google Scholar 

  7. Hsueh EC, Hansen N, Armando EG. Intraoperative lymphatic mapping and sentinel lymph node dissection in breast carcinoma.CA Cancer J Clin 2000;50:279–91.

    PubMed  CAS  Google Scholar 

  8. Giuliano AE, Barth D, Spivak B, Beitsch PD, Evans SW. Incidence and predictors of axillary metastases in T1 carcinoma of the breast.J. Am Coll Surg 1996;183:185–9.

    PubMed  CAS  Google Scholar 

  9. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sertinel lymphadenectomy for breast cancer.Ann Surg 1994; 220:391–401.

    Article  PubMed  CAS  Google Scholar 

  10. Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer.J. Clin Oncol 1997;15:2345–50.

    PubMed  CAS  Google Scholar 

  11. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.Lancet 1997;349:1864–7.

    Article  PubMed  CAS  Google Scholar 

  12. Krag DN, Weaver DL, Ashikaga T, et al. Sentinel node in breast cancer.N Engl J Med 1998;339:941–6.

    Article  PubMed  CAS  Google Scholar 

  13. Dale PS, Williams JT IV. Axillary staging utilizing selective sentinel lymphadenectomy for patients with breast cancer.Am Surg 1998;64:28–32.

    PubMed  CAS  Google Scholar 

  14. Koller M, Barsuk D, Zippel D, et al. Sentinel lymph node involvement—a predictor for axillary node status with breast cancer—has the time come.Eur J Surg Oncol 1998;24:166–8.

    Article  PubMed  CAS  Google Scholar 

  15. Sapunar F, Smith IE. Neoajuvant chemotherapy for breast cancer.Ann Med 2000;32:43–50.

    PubMed  CAS  Google Scholar 

  16. Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18.J. Clin Oncol 1997;15:2483–93.

    PubMed  CAS  Google Scholar 

  17. Nason KS, Anderson BO, Byrd DR, et al. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma.Cancer 2000;89:2187–94.

    Article  PubMed  CAS  Google Scholar 

  18. Cody HS III, Fey J, Akhurst T, et al. Complementarity of blue dye and isotope in sentinel node localization for breast cancer: univariate and multivariate analysis of 966 procedures.Ann Surg Oncol 2001;8:13–9.

    PubMed  Google Scholar 

  19. Cohen LF, Breslin TM, Kuerer HM, ross MI, Hunt KK, Sahin AA. Identification and evaluation of axillary sentinel lymph nodes in patients with breast carcinoma treated with neoadjuvant chemotherapy.Am J Surg Pathol 2000;9:1266–72.

    Google Scholar 

  20. Cox CE, Pendas S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer.Ann Surg 1998;227:645–53.

    Article  PubMed  CAS  Google Scholar 

  21. Cody HS, Hill A, Tran KN, et al. Credentialing for breast lymphatic mapping: how many cases are enough?.Ann Surg 1999;229: 723–8.

    Article  PubMed  Google Scholar 

  22. Kane JM III, Edge SB, Winston JS, Watroba N, Hurd TC. Intraoperative pathologic evaluation of a breast cancer sentinel lymph node biopsy as a determinant for synchronous axillary lymph node dissection.Ann Surg Oncol 2001;8:361–7.

    Article  PubMed  Google Scholar 

  23. Motomura K, Inaji H, Komoike Y, et al. Intraoperative sentinel lymph node examination by imprint cytology and frozen section during breast surgery.Br J Surg 2000;87:597–601.

    Article  PubMed  CAS  Google Scholar 

  24. Van Diest PJ, Torrenga H, Borgstein PJ, et al. Reliability of intraoperative frozen section and imprint cytological investigation of sentinel lymph nodes in breast cancer.Histopathology 1999;35: 14–8.

    Article  PubMed  Google Scholar 

  25. Weiser MR, Montgomery LL, Susnik B, Tan LK, Borgen PI, Cody HS III. Is routine intraoperative frozen-section examination of sentinel lymph nodes in breast cancer worthwhile?.Ann Surg Oncol 2000;7:651–5.

    Article  PubMed  CAS  Google Scholar 

  26. O'Hea BJ, Hill AD, El-Shirbiny AM, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center.J Am Coll Surg 1998;186:423–7.

    Article  PubMed  Google Scholar 

  27. Hainsworth PJ, Tjandra JJ, Stillwell RG, et al. Detection and significance of occult metastases in node-negative breast cancer.Br J Surg 1993;80:459–63.

    Article  PubMed  CAS  Google Scholar 

  28. Pendas S, Dauway E, Cox CE, et al. Sentinel node biopsy and cytokeratin staining for the accurate staging of 478 breast cancer patients.Am Surg 1999;65:500–5.

    PubMed  CAS  Google Scholar 

  29. McGuckin MA, Cummings MC, Walsh MD, Hohn BG, Bennett IC, Wright RG. Occult axillary node metastases in breast cancer: their detection and prognostic significance.Br J Cancer 1996;73: 88–95.

    PubMed  CAS  Google Scholar 

  30. Wells CA, Heryet A, Brochier J, et al. The immunocytochemical detection of axillary micrometastases in breast cancer.Br J Cancer 1984;50:193–7.

    PubMed  CAS  Google Scholar 

  31. De Mascarek I, Bonichon F, Coindre JM, Trojani M. Prognostic significance of breast cancer axillary lymph node micrometastases assessed by two special techniques: re-evaluation with longer follow-up.Br J Cancer 1992;66:523–7.

    Google Scholar 

  32. Kruerer HM, Newman LA, Buzdar AU, et al. Residual metastatic axillary lymph node post neoadjuvant chemotherapy predicts disease-free survival in patients with locally advanced breast carcinoma.Am J Surg 1998;176:502–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., 78229, San Antonio, TX

    Alexander R. Miller MD, Virginia E. Thomason MD, Jay Stauffer MD, Morton S. Kahlenberg MD & Anatolio B. Cruz Jr MD

  2. Division of Pathology, University of Texas Health Science Center at San Antonio, Texas

    I-Tien Yeh MD, Amin Alrahwan MD & Francis E. Sharkey MD

  3. Division of Radiology, University of Texas Health Science Center at San Antonio, Texas

    Pamela M. Otto MD, Claire McKay DO & William T. Phillips MD

Authors
  1. Alexander R. Miller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Virginia E. Thomason MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I-Tien Yeh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amin Alrahwan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francis E. Sharkey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jay Stauffer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pamela M. Otto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Claire McKay DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Morton S. Kahlenberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. William T. Phillips MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Anatolio B. Cruz Jr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander R. Miller MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miller, A.R., Thomason, V.E., Yeh, IT. et al. Analysis of sentinel lymph node mapping with immediate pathologic review in patients receiving preoperative chemotherapy for breast carcinoma. Annals of Surgical Oncology 9, 243–247 (2002). https://doi.org/10.1007/BF02573061

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02573061

Key Words

Search

Navigation