To validate sentinel node biopsy (SLN) for patients with complete axillary response to preoperative chemotherapy

1. LOCALLY ADVANCED BREAST CANCER: SENTINEL
NODE BIOPSY AFTER NEOADJUVANT
CHEMOTHERAPY
SUPPORTED BY
XIV World Congress on Breast Diseases
Senology 2006
(May 18-21, 2006, Zagreb, Croatia

2. LOCALLY ADVANCED BREAST CANCER: SENTINEL
NODE BIOPSY AFTER NEOADJUVANT
CHEMOTHERAPY
A. MORENO, JM ROMAN, O. OVIEDO, M MERCHAN, V FURIO, M. MARTIN,
JL CARRERAS, JA VIDART
SUPPORTED BY
GYNECOLOGY, BREAST SERVICE, SAN CARLOS HOSPITAL, MADRID,
SPAIN
XIV World Congress on Breast Diseases
Senology 2006
(May 18-21, 2006, Zagreb, Croatia

3. OBJETIVES
To validate sentinel node biopsy (SLN) for
patients with complete axillary response to
preoperative chemotherapy.
To determine accuracy of preoperative positron emission tomography (PET) to detect node metastases
after clinical axillary remission with neoadjuvant treatment.

4. • Prospective study.
• Recruitment period: Jan 2001- Dec 2005.
• 1.543 breast cancers were treated in our Department
• A total of 120 locally advanced breast cancers were
diagnosed, and 98 (81.6%) were submitted for neoadyuvant
treatment.
MATERIAL AND METHODS
LABC
NEOADYUVANT
COM PLETE
RESP

5. MATERIAL AND METHODS
36 patients with complete remission in axilla
PET
SLN
complete lymphadenectomy.
120 patients with LABC
98 Neoadjuvant treatment
EXTENSION OF TUMOR
•DIGITAL MAMMOGRAPHY
•BREAST & AXILLAR SONOGRAPHY, FNAC
•THORACIC CT, ABD CT, GAMMAGRAPHY
RESPONSE TO TREATMENT
•DIGITAL MAMMOGRAPHY
•BREAST & AXILLAR SONOGRAPHY
•BREAST RMN
COMPARISON BETWEEN TECHNIQUES:
COMPARISON PET- SLN
•SENSIBILITY
•FALSE NEGATIVE RATE
•NEGATIVE PREDICTIVE VALUE
•ACCURACY

6. DIGITAL MAMMOGRAM: BREAST BIOPSY
•Select areas

7. •Irregular margins
•Long axis
•Poor transmision
•Shadowing
SONOGRAPHIC STUDY OF BREAST
TUMOR

8. SONOGRAPHIC STATIFICATION OF
AXILLA

9. MATERIAL AND METHODS
36 patients with complete remission in axilla
PET
SLN
complete lymphadenectomy.
120 patients with LABC
98 Neoadjuvant treatment
EXTENSION OF TUMOR
DIGITAL MAMMOGRAPHY
BREAST & AXILLAR SONOGRAPHY, FNAC
THORACIC CT, ABD CT, GAMMAGRAPHY
RESPONSE TO TREATMENT
•DIGITAL MAMMOGRAPHY
•BREAST & AXILLAR SONOGRAPHY
•BREAST RMN
COMPARISON BETWEEN
TECHNIQUES:
COMPARISON PET- SLN-SLN small
•SENSIBILITY
•FALSE NEGATIVE RATE
•NEGATIVE PREDICTIVE VALUE
•ACCURACY

10. MATERIAL AND METHODS: PET
Cuts: Coronal, sagital, transverse
Correction of atenuation: TAC 90 kV 165 mA
Radiotracer: 18F-FDG (Fluoro-desoxi-glucose)
Dose: 7.81 mCi

11. SURGERY: SLNB FOR LABC: SAN
CARLOS EXPERIENCE
Tc99m INJECTION SITE:
SUBAREOLAR
•4 Doses Intradermic
• Tc 99m
•1-20 h. previous to surgery
GAMMAGRAPHY:
ANTERIOR/LATERAL VIEWS
•4 sites of injection 3 sentinel
nodes
•Location: Level I

12. SURGERY: SLNB FOR LABC: SAN
CARLOS EXPERIENCE
•Sentinel node biopsy is followed by complete axillary disection.
•Both results are compared

13. RESULTS: SLN
94,70%
88,80% 91,70%
73,60%
6,60%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
80,0%
90,0%
100,0%
NPV AAS TS S FNR

14. VARIABLES
•Negative Predictive Value
•Ability to Accurately Stage
•Technical Success
•Sensibility
•False Negative Rate
SLN in LABC
94.7%,
88.8%
91.7%
73.6%
6.6%
COMPARISON BETWEEN TECHNIQUES
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NPV AAS TS S FNR
SLN LABC
SLN small
tumors
SLN in small
98%,
98%
97%
96%
1.8%
p
n.s.
0.01
0.03
0.00
0.01

15. RESULTS
VARIABLES
•Negative Predictive Value
•Ability to Accurately Stage
•Technical Success
•Sensibility
•False Negative Rate
PET
69%,
75%
100%
43.7%
56.2%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
80,0%
90,0%
100,0%
NPV AAS TS S FNR

16. VARIABLES
•Negative Predictive Value
•Ability to Accurately Stage
•Technical Success
•Sensibility
•False Negative Rate
SLN in LABC
94.7%,
88.8%
91.7%
93.6%
6.6%
PET
69%,
75%
100%
43.7%
56.2%
p
0.02
0.01
>0.05
0,00
0,00
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
80,0%
90,0%
100,0%
NPV AAS TS S FNR
SLN
PET
COMPARISON BETWEEN TECHNIQUES

17. CONCLUSIONS
• SLN will play an important role to assess tumor response to
chemotherapy, and should be planned if no residual
disease is found in axilla by imaging techniques, followed
by complete lymphadenectomy until larger studies show
their results.

18. CONCLUSIONS
• PET has demonstrated a low capability to detect or discard
axillary disease for patients with LABC after neoadjuvant
chemotherapy.
• SLN remains better to correctly statify the axilla, although
further studies must corroborate these findings for LABC.