Identification and Resection of Clipped Node Decreases the False negative Rate of Sentinel Lymph Node Surgery in Patients Presenting With Node positive Breast Cancer (T0 T4, N1 N2) Who Receive Neoadjuvant Chemotherapy: Results From ACOSOG Z1071 (Alliance)
Background:The American College of Surgeons Oncology Group Z1071 trial reported a false negative rate (FNR) of 12.6% with sentinel lymph node (SLN) surgery after neoadjuvant chemotherapy in women presenting with node positive breast cancer. One proposed method to decrease the FNR is clip placement in the positive node at initial diagnosis with confirmation of clipped node resection at surgery. Methods:Z1071 was a multi institutional trial wherein women with clinical T0 T4,N1 N2,M0 breast cancer underwent SLN surgery and axillary dissection (ALND) after neoadjuvant chemotherapy. In cases with a clip placed in the node, the clip location at surgery (SLN or ALND) was evaluated. Results:A clip was placed at initial node biopsy in 203 patients. In the 170 (83.7% patients with cN1 disease and at least 2 SLNs resected, clip location was confirmed in 141 cases. In 107 (75.9% patients where the clipped node was within the SLN specimen, the FNR was 6.8% (confidence interval [CI] 1.9% 16.5% In 34 (24.1% cases where the clipped node was in the ALND specimen, the FNR was 19.0% (CI: 5.4% 41.9% In cases without a clip placed (n 355) and in those where clipped node location was not confirmed at surgery (n 29) the FNR was 13.4% and 14.3% respectively. Conclusions:Clip placement at diagnosis of node positive disease with removal of the clipped node during SLN surgery reduces the FNR of SLN surgery after neoadjuvant chemotherapy. Clip placement in the biopsy proven node at diagnosis and evaluation of resected specimens for the clipped node should be considered when conducting SLN surgery in this setting.
Annals of surgery