Krivorotko, P. V., Tabagua, T. T., Novikov, S. N., Amirov, N., Levchenko, V. E., Pesotsky , R. S., Emelyanov, A. S., Mortada, V. V., Zhiltsova, E. K., Semiglazov, V. V., Krzhivitsky, P. I., Artemyeva, A. S., Donskih, R. V., & Semiglazov, V. F. (2024). The Sentiel Lymph Node Biopsy in breast cancer . Voprosy Onkologii, 70(3), 516–525. https://doi.org/10.37469/0507-3758-2024-70-3-516-525

Abstract

Introduction. This paper presents a retrospective analysis of the use of sentinel lymph node biopsy (SLNB) in patient groups under-represented in existing clinical trials. Disease-free survival was analysed in the groups of patients with stage cT3, multicentric forms of cancer and patients treated by mastectomy and one-stage reconstruction with endoprosthesis.

Aim. To evaluate the safety of the SLNB procedure in patients with multicentric tumors, cohort of patients with clinical stage cT3N0M0, group of patients with mastectomy and single-stage reconstruction with endoprosthesis; to analyse the survival rate of patients with clinical stage cT1-3N0M0 depending on the biological subtype of the tumour in whom the SLNB results revealed 1-2 macromestases; and to evaluate the necessity of intraoperative histological examination of SLN in patients with cN0 status.

Materials and Methods. We performed a retrospective analysis of 2 854 patients who underwent surgery at the Department of Breast Tumours, N.N. Petrov National Medical Research Centre of Oncology. The SLB procedure was most commonly performed using Tc-99m sulphur colloid. Urgent histological examination was performed at the discretion of the operating surgeon. In case of urgent histological examination, LN status was assessed using the frozen section technique. In 607 patients with 1-2 macrometastases in the SLN, 5-year DFS was evaluated according to the biological subtype of the tumor. Patients with multicentric forms of BC, those who had undergone mastectomy and women with clinical stage T3 BC were allocated to separate groups. In these groups, the 5-year regional recurrence rate and 5-year DFS were evaluated according to the volume of axillary surgery performed.

Results. In patients with multicentric tumors, DFS was 88.7 % in the axillary lymph node dissection (ALD) group and 89.5 % without LND [HR 0.997 (95 % CI 0.207-4.802)]. The number of axillary recurrences was 1 (1.2 %) in the ALD group and 2 (2.5 %) in the non-ALD group. In patients with clinical stage cT3N0M0, the DFS was 80.8 % in the group with ALD and 82.7 % in the group without ALD [HR 1.018 (95 % CI 0.333 to 3.111)]. Axillary recurrences were observed in 3 patients (3.9 %) in the ALD group and 3 patients (3.9 %) in the non-ALD group. After mastectomy and single-stage reconstruction with endoprosthesis, DFS was 85.8 % in the ALD group and 90.5 % without ALD [HR 1.847 (95 % CI 0.808 to 4.219)]. The number of axillary recurrences was 3 (3.5 %) in the group with ALD and 4 (3.4 %) in the group without ALD. Among patients with 1-2 macrometastases in lymph nodes, DFS by biological subtype was as follows 84 % for luminal A, 81.7 % — for luminal B, 76.2 % — for HER2-positive and 77.8 % — for triple-negative BC (p = 0.075). We analyzed 915 patients who underwent SLNB without urgent histological examinations. Of these, 1 or 2 affected lymph nodes were identified in 106 (11.6 %) and 65 (7.1 %) patients, respectively. 3 or more affected lymph nodes were identified in 17 (1.9 %) patients. In the remaining 727 patients (79.4 %), no tumor cells were found in the lymph nodes according to postoperative histological data.

https://doi.org/10.37469/0507-3758-2024-70-3-516-525

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