Sentinel lymph node biopsy for breast cancer restaging

Aim. To study the role of SLNB in patients with primary operable breast cancer (T1–2N0/N0–1) in restaging depending on the involvement of regional lymph flow (N status). Materials and methods. The retrospective study included 956 women with ductal/lobular stage I–IIB breast cancer. The median age was 54 [45; 63] years. According to the TNM clinical staging system, the patients predominantly had stage IA and IIA cancer. In 94 % of patients, no involvement of the SLN was detected. N+ status was registered in 6 % of patients. Histologically, breast cancer was predominantly represented by invasive ductal carcinoma in 87.5 % of the patients. Depending on the molecular subtype, luminal B HER2neu negative breast cancer was found in 38.2 % of the patients and luminal A subtype in 29.6 %. Moderately differentiated breast cancer was found in 63.5 % of the patients. Results. Median follow-up of the patients was 70.6 [60.0; 82.0] months. Depending on the involvement of the SLN, the following sentinel lymph node biopsy showed the following results: in 77.5 % of the patients, cN0 was confirmed histologically (pN0); in 2.7 %, SLN involvement was staged both clinically and pathologically (cN1–pN1); in 2.8 %, de-escalation of staging was detected (cN1–pN0); and in 0.6 %, SLNB revealed larger volume of damage to the regional lymph collector (cN1–pN2–3). 20 % of the patients underwent neoadjuvant chemotherapy (NACT). Among patients with cN1, SLN involvement (pN1) was significantly more often detected histologically in the group after NACT, 6.8 % versus 1.7 % (p = 0.0001), respectively. In 2.8 % with cN1–pN0, NACT efficacy was significantly higher (12.1 % versus 0.5 %, p = 0.00001). Also, in 16.3 % of the patients, pN1 was significantly more common in the group without NACT (18.5 % versus 7.4 %, p = 0.0002). Conclusion. Conducting SLNB restaged the involvement of the regional lymph collector of T1–2N0/N0–1 patients in 189 (19.8 %) cases. According to the results of SLNB, in 528 (55.2 %) patients with breast cancer, it was possible to refuse lymphadenectomy.

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