Retrospective study of long-term outcome in patients with nodal-positive breast cancer treated with sentinel lymph node biopsy alone after neoadjuvant chemotherapy

Sentinel lymph node biopsy (SLNB) has yet to be accepted as the standard staging procedure in node positive (cN1) breast cancer patients who have clinical complete response in the axilla (cN0) following neoadjuvant chemotherapy (NACT). A retrospective study at Asan Medical Center (Seoul, South Korea) compared SLNB versus axillary lymph node dissection (ALND) in ypN0 patients after NACT. At a median follow-up of 65 months, the axillary recurrence rate was 3.2% in the SLNB only group and 1.8% in the ALND group (p=0.398). Disease-free survival (p=0.011) and overall survival (p=0.047) were significantly worse in the ALND group. In the ALND group more patients had T3-4 tumors. Among the T1-2 patients there was no significant difference in DFS (p=0.242) and OS (p=0.761) between the SLNB only and the ALND groups. The authors conclude that cN1 patients who were converted to ypN0 following NACT may be safely treated with SLNB only.