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Clin Breast Cancer. 2018 Feb;18(1):e73-e77. doi: 10.1016/j.clbc.2017.06.014. Epub 2017 Jul 10.

Prospective Feasibility Trial of Sentinel Lymph Node Biopsy in the Setting of Inflammatory Breast Cancer.

Author information

1
Department of Breast Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX. Electronic address: sgainer@mdanderson.org.
2
Department of Breast Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
3
Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
4
Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
5
Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
6
Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
7
Department of Breast Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Abstract

BACKGROUND:

Most inflammatory breast cancer (IBC) patients have axillary disease at presentation. Current standard is axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NACT). Advances in NACT have improved pathologic complete response (pCR) rates increasing interest in performing sentinel lymph node (SLN) biopsy (SLNB). Previous studies on SLNB for IBC patients did not assess nodal response with imaging or use dual tracer mapping. We sought to prospectively determine false negative rates of SLNB in IBC patients using dual tracer mapping, and to correlate pathology with preoperative axillary imaging.

PATIENTS AND METHODS:

Patients with IBC were prospectively enrolled. Patients underwent axillary staging with physical examination and axillary ultrasound before and after NACT. All patients underwent SLNB using blue dye and radioisotope, followed by ALND.

RESULTS:

Sixteen patients were prospectively enrolled. Clinical N stage was N0 in 1 patient, N1 in 8, and N3 in 7. SLN mapping was successful in only 4 patients (25%) with 12 (75%) not draining either tracer to a SLN. Three of the 4 (75%) who mapped had an axillary pCR. The patient who mapped but did not have an axillary pCR had a positive SLNB with additional axillary nodal disease identified on ALND. All patients who successfully mapped had presumed residual nodal disease on preoperative axillary ultrasound.

CONCLUSION:

SLNB was unsuccessful in most IBC patients. A small subset who have pCR might undergo successful SLNB, but preoperative axillary imaging failed to identify these patients. ALND should remain standard practice for IBC patients.

KEYWORDS:

Dual tracer; Inflammatory breast cancer; Lymph node mapping; Nodal response; Sentinel lymph node biopsy

PMID:
28755879
DOI:
10.1016/j.clbc.2017.06.014

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