Возможности применения БСЛУ у больных раком молочной железы стадии сТ4N0-1M0 (ycN0) после неоадъювантного лекарственного лечения

Kurbanova, M. B., Amosova, V. A., Frolova, M. A., Denchik, D. A., Baychorov, E., Stilidi, I. S., & Petrovsky , A. V. (2026). Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Stage cT4N0-1M0 (ycN0) After Neoadjuvant Systemic Therapy. Voprosy Onkologii, 72(1), OF–2474. https://doi.org/10.37469/0507-3758-2026-72-1-OF-2474

Abstract

Introduction. Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in early breast cancer (BC). However, its role in patients with locally advanced disease (cT4N0-1) following neoadjuvant systemic therapy (NAST) remains debatable.

Aim. To evaluate the diagnostic accuracy of SLNB in patients with stage cT4N0-1M0 (ycN0) BC after NAST.

Materials and Methods. This prospective study included 63 patients with stage cT4N0-1M0 BC who underwent NAST followed by mastectomy with SLNB and completion axillary lymph node dissection (ALND). Sentinel nodes were identified using a radioisotope method (99mTc-Nanotop). The study assessed the sentinel lymph node detection rate, false-negative rate (FNR), sensitivity, and negative predictive value.

Results. The sentinel lymph node detection rate was 95% (60/63). Metastatic involvement was identified in 38.3% of cases (23/60). The FNR was 5.6% (4 cases), sensitivity was 85%, and negative predictive value was 90%. A pathological complete response (pCR) was achieved in 24% of patients, most frequently in the HER2-positive subtype (63%). Univariate regression analysis revealed that the FNR decreased as the number of lymph nodes removed increased. When a single lymph node was removed (7 patients), the FNR was 42% (3 cases). In contrast, when three lymph nodes were removed (29 patients), the FNR was 3% (1 case) (p = 0.012).

Conclusion. Radioisotope-guided SLNB demonstrates high diagnostic accuracy in patients with cT4N0-1 BC after NAST. These findings suggest that SLNB can be considered a viable alternative to ALND, provided that at least three sentinel lymph nodes are successfully removed.

https://doi.org/10.37469/0507-3758-2026-72-1-OF-2474

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References

Lucci A., Linda Mackie McCall, Peter D Beitsch, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group trial Z0011. J Clin Oncol. 2007; 25(24): 3657-3663.-DOI: https://doi.org/10.1200/JCO.2006.07.4062.

Veronesi U., Paganelli G., Viale G., et al. A randomized comparison of sentinel node biopsy with routine axillary dissection in breast cancer. Women’s Oncology Review. 2003; 349(6): 546-53.-DOI: https://doi.org/10.1056/NEJMoa012782.

Veronesi U., Paganelli G., Viale G., et al. Sentinel lymph node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol. 2006; 7(12): 983-90.-DOI: https://doi.org/10.1016/S1470-2045(06)70947-0.

Piltin M.A., Hoskin T.L., Day C.N., et al. Oncologic outcomes of sentinel lymph node surgery after neoadjuvant chemotherapy for node positive breast cancer. Ann Surg Oncol. 2020; 27 (12): 4795-4801.-DOI: https://doi.org/10.1245/s10434-020-08900-0.

Старкова М.В., Зикиряходжаев А.Д., Грушина Т.И., et al. Диагностическая значимость биопсии сторожевого лимфатического узла у больных ранним раком молочной железы. Онкология. Журнал им. П.А. Герцена. 2019; 8(6): 422 427.-DOI: https://doi.org/10.17116/onkolog20198061422. [Starkova M.V., Zikiryakhodzhaev A.D., Grushina T.I., et al. Diagnostic value of sentinel lymph node biopsy in patients with early breast cancer. P.A. Herzen Journal of Oncology. 2019; 8(6): 422 427.-DOI: https://doi.org/10.17116/onkolog20198061422 (In Rus)].

Charfare H., Limongelli S., Purushotham A.D. Neoadjuvant chemotherapy in breast cancer. Br J Surg. 2005; 92(1): 14-23.-DOI: https://doi.org/10.1002/bjs.4840.

Nason K.S., Anderson B.O., Byrd D.R., et al. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer. 2000; 89(11): 2187-94.

Pecha V., Kolarik D., Kozevnikova R., et al. Sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy. Cancer. 2011; 117(20): 4606-16.-DOI: https://doi.org/10.1002/cncr.26102.

Canavese G., Dozin B., Vecchio C., et al. Accuracy of sentinel lymph node biopsy after neo-adjuvant chemotherapy in patients with locally advanced breast cancer and clinically positive axillary nodes. Eur J Surg Oncol. 2011; 37(8): 688-94.-DOI: https://doi.org/10.1016/j.ejso.2011.05.012.

El Hage Chehade H., Headon H., El Tokhy O., et al. Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients. Am J Surg. 2016; 212(5): 969-981.-DOI: https://doi.org/10.1016/j.amjsurg.2016.07.018.

Tan V.K.M., Goh B.K.P., Fook‐Chong S., et al. The feasibility and accuracy of sentinel lymph node biopsy in clinically node-negative patients after neoadjuvant chemotherapy for breast cancer - A systematic review and meta-analysis. J Surg Oncol. 2011; 104 (1): 97-103.-DOI: https://doi.org/10.1002/jso.21911.

Lyman G.H., Temin S., Edge S.B., et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014; 32(13): 1365-83.-DOI: https://doi.org/10.1200/JCO.2016.71.0947.

Giuliano A.E., Ballman K.V., McCall L., et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA. 2017; 318(10): 918-926.-DOI: https://doi.org/10.1001/jama.2017.11470.

von Minckwitz G., Untch M., Blohmer J.U., et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012; 30(15): 1796-1804.-DOI: https://doi.org/10.1200/JCO.2011.38.8595.

Classe J.M., Loaec C., Gimbergues P., et al. Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study. Breast Cancer Res Treat. 2019; 173(2): 343-352.-DOI: https://doi.org/10.1007/s10549-018-5004-7.

Berberoglu K., Erdemir A., Rasa K., et al. Role of gamma probe-assisted intraoperative sentinel lymph node evaluation in predicting axillary breast cancer metastasis after neoadjuvant chemotherapy. Nucl Med Commun. 2020; 41(2): 120-125.-DOI: https://doi.org/10.1097/MNM.0000000000001111.

Lee S.B., Kim H., Kim J., et al. Prognosis according to clini-cal and pathologic lymph node status in breast cancer patients who underwent sentinel lymph node biopsy alone after neo-adjuvant therapy. PLoS ONE. 2021; 16(5): e0251597.-DOI: https://doi.org/10.1371/journal.pone.0251597.

Jimenez-Gomez M., Loro-Pérez J., Vega-Benítez V., et al. Axillary management in patients with breast cancer and positive axilla at diagnosis. Experience in a Spanish university hospital with a 5-year follow-up. J Cancer Res Ther. 2023; 19(2): 183-190.-DOI: https://doi.org/10.4103/jcrt.jcrt_263_22.

Andreis D., Bonardi S., Allevi G., et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with T2 to T4, N0 and N1 breast cancer. Breast. 2016; 29: 55-61.-DOI: https://doi.org/10.1016/j.breast.2016.07.003.

Tee S.R., Devane L.A., Evoy D., et al. Meta-analysis of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer. Br J Surg. 2018; 105(12): 1541-1552.-DOI: https://doi.org/10.1002/bjs.10986.

Емельянов А., Криворотько П., Жильцова Е., et al. Хирургическое стадирование аксиллярной области у больных раком молочной железы категории сN+ перешедших в категорию ycN0 после неоадъювантной терапии. Вопросы онкологии. 2022; 68(3): 322-332.-DOI: https://doi.org/10.37469/0507-3758-2022-68-3-322-332. [Emelyanov A.S., Krivorotko P.V., Zhiltsova E.K., et al. SemiglazovAxillary surgery after neoadjuvant chemotherapy in breast cancer patients downstaging from cN+ to ycN0. Voprosy Onkologii = Problems in Oncology. 2022; 68(3): 322-332.-DOI: https://doi.org/10.37469/0507-3758-2022-68-3-322-332 (In Rus)].

Dominici L.S., Negron Gonzalez V.M., Buzdar A.U., et al. Cyto-logically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2- positive breast cancer. Cancer. 2010; 116(12): 2884-9.-DOI: https://doi.org/10.1002/cncr.25152.

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