Objective
Recently there are efforts to utilize sentinel lymph node biopsy (SLNB) techniques after neoadjuvant chemotherapy (NAC) to minimize axillary surgery. However, studies have demonstrated higher false-negative rates in this scenario, which may result in inaccurate assessment of treatment response and patient prognosis as well as leaving residual disease behind. In this study, we describe the use of reflector-guided excision of the percutaneously biopsied node (PBN) as an aide to conventional SLNB and its predictor of the axillary status following NAC.
Methods
Single-institution analysis of patients undergoing axillary fiducial-reflector placement and subsequent SLNB compared with conventional SLNB.
Results
Nineteen patients in the reflector-group were matched with 19 patients who underwent conventional SLNB (conventional-group). The PBN was identified in the SLNB in 19 patients (100%) in the reflector-group and in 9 patients (47.3%) in the conventional-group (p=0.002). In the remaining 10 patients in the conventional-group, the PBN was identified in the axillary lymph node dissection (ALND) specimen in 4 patients (21%) and not identified in 6 patients (31.7%). Among the 38 patients, traditional mapping failed to identify the PBN in 13 patients (34.2%). The PBN was negative in 10 patients (36%) and positive in 18 patients (64%); no additional positive nodes were identified among patients with a negative PBN, correctly reflecting the status of the axilla in 100% of cases.
Conclusion
Mapping failure after neoadjuvant chemotherapy may compromise SLNB. Reflector-guided excision of the PBN is not only facile and feasible, but more accurately reflects the status of the axilla following NAC.