The role of sentinal lymph node biopsy in determining the need for completion axillary node dissection after neoadjuvant chemotherapy in patients with lymph node positive breast cancer

Abstract

S: POSTER PRESENTATIONS (MD) has been suggested as a potential adjunct to fin'ther characterize atypia in this setting. The purpose of the study was to help establish the role of MD in asymptomatic high-risk patients and correlate cytologic findings from DL and MD washings with histology from the duct producing the atypia. METHODS: 77 consenting women at high risk for developing breast cancer underwent DL. Those who produced atypia went on to MD and duct excision. Cytology from DL and MD washings, endoscopic findings, and histology of duct excision specimens were correlated. RESULTS: 59/77 (77%) of patients produced nipple aspirate fluid. 46/59 (78%) had satisfactory specimens yielding ductal cells. 19/59 (32%) patients had atypical results (mild) of which 4 patients had bilateral atypia. An average of 2.4 ducts were lavaged per patient. The atypia yield per lavaged duct was 16%(23/143). To date, 14 patients have undergone attempted operative ductoscopy (3 bilateral), of which one was unsuccessful and no excision was performed. 11/17 (65%) breasts were successfully scoped and a lesion was visualized in 8/11 cases. Excision was possible after placement of an angiocath or small lacrimal probe and blue dye in 5 of the 6 cases where ductoscopy was unsuccessful. Washings through the scope were acellular in 1 case; benign duct cells in 3; mild atypia in 5, and marked atypia in 2. Of the 16 duct excisions, only 2 (13%) were found to have premalignant lesions (both atypical lobular hyperplasia). 3 patients had intraductal papillomas; 8 had benign ductal hyperplasia, and 3 had fibrocystic change or ectasia. CONCLUSION: Not all atypia found on ductal lavage may be from premalignant lesions. Mammary ductoscopy may help identify cases in which atypia is from benign, proliferative lesions. P63 The role of sentinal lymph node biopsy in determining the need for completion axillary node dissection after neoadjuvant chemotherapy in patients with lymph node positive breast cancer A. Khan,* M. Sabel, K. Diehl, A. Schott, V. Cimmino, A. Chang, C. Kleer, L.A. Newman. surgical oneology, university of michigan, ann arbor, MI. Background: Many institutions have adopted the practice of nodal staging prior to delivery of neoadjuvant chemotherapy (neoCTX). Current standard of care mandates a completion axillary lymph node dissection (ALND) for node-positive patients (pts). Our goal was to evaluate the feasibility of avoiding this ALND in selected node positive pts, since it is known that metastases (mets) will be limited to the SLN in many pts, and neoCTX can sterilize mets in others. Methods: From 2001-2003, 65 pts registered in a prospectively maintained breast cancer database underwent pre-CTX axillary staging. Post-CTX ALND results were analyzed. Results: 24/65 neoCTX pts were node-positive at presentation by SLN biopsy (15/24, 63%) or ultrasoundguided needle biopsy (9/24, 37%). Forty-one cases (63%) had a negative pre-CTX SLN biopsy and required no further axillary surgery. 20/24 cases (83%) have undergone completion ALND following neoCTX; one pt refused surgery and has no evidence of disease at 1 year flu. Surgery is pending in 3. There were no residual axillary mets in 8 cases (38%). 18/21 pts (86%) experienced a partial or complete primary breast tumor response; of the 3 with no response only one had residual axillary mets on ALND. Of the 8 pts with no residual axillary mets, complete clinical response was seen in 4(50%). Similarly, there were 5 complete responses (42%) among the 12 pts who had residual mets. Five pts had lymphatic mapping repeated at the time ofpost-CTX ALND, with successful identification of the SLN in 4 cases. The SLN contained mets in all 4 cases, ie there were no false negatives. In the one case of SLN non-identification there was complete histopathologic response in the breast, no residual axillary disease, and extensive axillary fibrosis consistent with CTX effect. Conclusion: For neoCTX pts with biopsy-proven axillary mets at presentation, repeat axillary staging at the time of definitive surgery with SLN biopsy appears to be the most promising procedure for the identification of pts with residual nodal disease. P64 Who Needs an Axillary Dissection? L.W. Hoque,* A.E. Loscalzo, J.E Day, J. Killeen, M.A. Zeug, S. Shaha. Research Department, Kapiolani Breast Center, Honolulu, H

DOI: 10.1007/BF02524130

Cite this paper

@article{Khan2006TheRO, title={The role of sentinal lymph node biopsy in determining the need for completion axillary node dissection after neoadjuvant chemotherapy in patients with lymph node positive breast cancer}, author={Asmara Khan and Michael S Sabel and Kevin Diehl and A-M. Schott and Vincenzo Cimmino and Alfred E. Chang and C. Kleer and Lisa Newman}, journal={Annals of Surgical Oncology}, year={2006}, volume={11}, pages={S102-S102} }