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. 2023 Jun 24;15(13):3325.
doi: 10.3390/cancers15133325.

Omitting Sentinel Lymph Node Biopsy after Neoadjuvant Systemic Therapy for Clinically Node Negative HER2 Positive and Triple Negative Breast Cancer: A Pooled Analysis

Munaser Alamoodi  1   2 , Umar Wazir  2   3 , Kinan Mokbel  2   4 , Neill Patani  2   5 , Jajini Varghese  2   6 , Kefah Mokbel  2
Affiliations

Omitting Sentinel Lymph Node Biopsy after Neoadjuvant Systemic Therapy for Clinically Node Negative HER2 Positive and Triple Negative Breast Cancer: A Pooled Analysis

Munaser Alamoodi et al. Cancers (Basel). .

Abstract

Recent advances in systemic treatment for breast cancer have been underpinned by recognising and exploiting subtype-specific vulnerabilities to achieve higher rates of pathologic complete response (pCR) after neo-adjuvant systemic therapy (NAST). This down-staging of disease has permitted safe surgical de-escalation in patients who respond well. Triple-negative (TNBC) or HER2-positive breast cancer is most likely to achieve complete radiological response (rCR) and pCR after NAST. Hence, for selected patients, particularly those who are clinically node-negative (cN0) at diagnosis, the probability of disease in the sentinel node after NAST could be low enough to justify omitting axillary surgery. The aim of this pooled analysis was to determine the rate of sentinel node positivity (ypN+) in patients with TNBC or HER2-positive breast cancer who were initially cN0, achieving rCR and/or pCR in the breast after NAST. MedLine was searched using appropriate search terms. Five studies (N = 3834) were included in the pooled analysis, yielding a pooled ypN+ rate of 2.16% (95% CI: 1.70-2.63). This is significantly lower than the acceptable false negative rate of sentinel lymph node biopsy (SLNB) and supports consideration of omission of SLNB in this subset of patients.

Keywords: breast cancer; clinically node negative; complete pathological response; complete radiological response; neoadjuvant systemic chemotherapy; pathological node negative; pathological node positive; sentinel lymph node biopsy.

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Conflict of interest statement

Kefah Mokbel has received honoraria for providing academic and clinical advice to Merit Medical. The other authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
CONSORT diagram for this study.
Figure 2
Figure 2
MRI demonstrating complete radiological response of a TNBC in the right breast after NAST that included Carboplatin and Pembrolizumab in a 50-year-old woman (left: before NAST; right: after NAST). The patient achieved pCR.
Figure 3
Figure 3
(a) A 50-year-old patient with extensive HER2-positive breast cancer in right upper outer quadrant. (b) MRI showed extensive mass and non-mass-like enhancement spanning 10 cm. The patient received neoadjuvant weekly Paclitaxel and Herceptin with Pertuzumab for three months. (c) post-NAST MRI showed a complete radiological response. The patient underwent nipple-sparing mastectomy and reconstruction with SLNB. The final histology confirmed pCR.
Figure 3
Figure 3
(a) A 50-year-old patient with extensive HER2-positive breast cancer in right upper outer quadrant. (b) MRI showed extensive mass and non-mass-like enhancement spanning 10 cm. The patient received neoadjuvant weekly Paclitaxel and Herceptin with Pertuzumab for three months. (c) post-NAST MRI showed a complete radiological response. The patient underwent nipple-sparing mastectomy and reconstruction with SLNB. The final histology confirmed pCR.
See this image and copyright information in PMC

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