AB035. SOH24AB_121. Assessing factors associated with further nodal positivity in initially node positive breast cancer patients found to have a positive sentinel node after neoadjuvant chemotherapy
Clinical Breast Session

AB035. SOH24AB_121. Assessing factors associated with further nodal positivity in initially node positive breast cancer patients found to have a positive sentinel node after neoadjuvant chemotherapy

Yeong Huei Desmond Chuah, Damian McCartan, Claire Rutherford, Denis Evoy, Jane Rothwell, Ruth Prichard, Michael Boland

Department of General, Breast and Endocrine Surgery, St Vincent’s University Hospital, Dublin, Ireland

Background: Axillary lymph node dissection (ALND) remains the standard of care for patients who were initially node positive and are found to have a positive sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NACT). Factors predictive of further nodal metastases in this group remain unclear. This study aimed to assess factors predictive of additional nodal positivity in patients with a positive SLNB after NACT.

Methods: Retrospective analyses were performed on a prospectively maintained breast cancer database from 2015 to 2020. Rate of SLNB positivity in initially node positive breast cancer patients post NACT was recorded. Factors associated with additional non-sentinel nodal positivity were assessed using Chi2 and student t-tests.

Results: Patients with positive SLNB after NACT (n=77) proceeded to ALND. The median number of sentinel lymph nodes (SLNs) excised was 4 (range: 1–6). Forty-seven patients had no further nodal disease and 30 had additional non-sentinel nodal positivity. Patients with further non-sentinel node positivity had a higher number of positive sentinel nodes compared to those with no further nodal disease (median 3 vs. 1; student t-test; P<0.05) as well as being more likely to have extranodal extension (Chi2 test; P=0.01). ER positivity (Chi2 test; P=0.19), HER2 negativity (Chi2 test; P=0.10) and the presence of macrometastatic (vs. micrometastatic/isolated tumour cells) disease (Chi2 test; P=0.07) were associated with a trend towards further non-sentinel node positivity after ALND.

Conclusions: More than half of the study group underwent unnecessary ALND as they had no further nodal positivity. Using pre-operative factors to identify patients who may not need ALND will be critical to reducing morbidity associated with this procedure.

Keywords: Axillary lymph node dissection (ALND); macrometastasis; neoadjuvant chemotherapy (NACT); node positive breast cancer; sentinel lymph node biopsy (SLNB)

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-24-ab035
Cite this abstract as: Chuah YHD, McCartan D, Rutherford C, Evoy D, Rothwell J, Prichard R, Boland M. AB035. SOH24AB_121. Assessing factors associated with further nodal positivity in initially node positive breast cancer patients found to have a positive sentinel node after neoadjuvant chemotherapy. Mesentery Peritoneum 2024;8:AB035.

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