Published in:
01-12-2018 | ASO Author Reflections
ASO Author Reflections: Low-Volume Sentinel Node Disease After Neoadjuvant Chemotherapy is Still an Indication for Axillary Dissection
Authors:
Tracy-Ann Moo, MD, Monica Morrow, MD
Published in:
Annals of Surgical Oncology
|
Special Issue 3/2018
Login to get access
Excerpt
A large body of literature has established the correlation between volume of disease in the sentinel lymph node (SLN) and non-SLN (NSLN) metastasis in patients undergoing primary surgery. These studies showed that only 10–20% of patients with low-volume disease (isolated tumor cells [ITCs] or micrometastases) in the SLN had positive NSLNs at completion axillary dissection.
1,2 In contrast, patients with macrometastasis in the SLN had a > 50% probability of positive NSLNs.
3 SLN biopsy use after neoadjuvant chemotherapy (NAC) in patients with cN0 and cN1-2 disease has been increasing. In this setting, the relationship between volume of disease in the SLN and NSLN metastases is unknown. Intraoperative frozen section (FS) of the SLN identifies patients with nodal disease for immediate axillary dissection and is known to have a lower sensitivity for detecting micrometastases and ITCs than macrometastases.
4 Whether a false-negative FS result after NAC is indicative of a low risk of residual axillary disease has also not been studied. …
