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Breast Cancer • Radiation Oncology
Based on the SENTINA trial, is it reasonable to allow for axillary assessment via SLNB alone (without axillary dissection) after neoadjuvant chemotherapy for an upfront clinically node-positive patient?
Would there be concern that the false negative rate be too high with a SLNB alone? Is this mitigated by having the clinically involved node clipped at time of biopsy and having surgeons remove more than one sentinel node at time of surgery? Would the standard of care still be considered for axillary dissection in these cases?
Answer from: Radiation Oncologist at Community Practice
False-negative is reduced to 5% or low with dual tracer, taking more than two sentinel nodes out and making sure bx positive node is clipped, localized, and taken out.
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Answer from: Radiation Oncologist at Academic Institution
I agree with @Imran Zoberi and @Sushil Beriwal, that SLNB is a reasonable way to evaluate the axilla following neoadjuvant CT for a clinically node-positive patient at diagnosis per the ACOSOG and Sentina trials and given the caveats mentioned. Perhaps a more significant question, however, is what a...
Answer from: Radiation Oncologist at Academic Institution
In a patient who has had a clinical complete nodal response to NAC, an SLNbx is the appropriate procedure. Based on data from SENTINA and ACOSOG Z1071, False Negative Rates (FNR) of <10% are achieved when blue and radiotracer dyes are used (controllable) or 3 or more SLNs are identified (we can't...
Answer from: Radiation Oncologist at Academic Institution
Yes.
Answer from: Radiation Oncologist at Community Practice
For Node(+) that converts to SN (-) after NA CTX. If the tumor is ER neg I would treat high tangents and Supraclav, but not full axilla or IM. If ER (+), I would treat high tangent only, unless multiple (2 or more) nodes were positive.
Answer from: Radiation Oncologist at Academic Institution
@Neil B. Newman, remember that up-front SLNB is not allowed in B51 (requires core needle or FNA), potentially due to concerns about high FNR from SENTINA, although I do not have the full protocol currently available to confirm or deny this from their introduction.I believe Dr. @Sushil Beriwal m...
Answer from: Radiation Oncologist at Academic Institution
To the points brought up by @Leonard Prosnitz and @Theodore E. Yaeger, NSABP B51 will answer whether omitting RNI in patients who have gone from cN1 to ypN0 is oncologically safe. So, perhaps, in the future (based on trial results), patients will have cN1 disease, get neoadjuvant chemotherapy, conve...
Answer from: Radiation Oncologist at Community Practice
Thank you all for the comments. Something I was getting at though, is whether we find in SNLB alone a sufficiently low FN rate if we have omission of RT arm in B51, since they need a pCR in the nodes. My bias, and of course, we will see the numbers for how many patients got ALMD plus/minus SLNB, wou...
Comments
Radiation Oncologist at Varian Medical Systems/Allegheny health network
False-negative in both SENTINA and ACSOG was more ...
False-negative in both SENTINA and ACSOG was more ...