Implementation of Sentinel Lymph Node Biopsy Following Neoadjuvant Chemotherapy in Clinically Node Positive Breast Cancer
*Alessandra Mele, *Jaime Pardo, *Amulya Alapati, *Stephamie Serres, Ted James
Beth Israel Deaconess Medical Center, Boston, MA
Objective: Clinical trials have evaluated the feasibility of sentinel lymph node biopsy (SLNB) in patients with clinically positive nodes undergoing neoadjuvant chemotherapy (NAC), suggesting that some patients may be eligible for minimally invasive axillary staging. We analyzed data from the National Cancer Database (NCDB) to assess implementation of SLNB following NAC for clinically node positive patients. Patients: Our cohort comprises women with stage 1-3 invasive breast cancer diagnosed between 2012-2015, of whom 31% underwent NAC followed by ALND. Nodal pathological complete response (pCR) was defined as absence of lymph node metastasis on final pathology. Descriptive statistics were performed to examine practice trends in different clinical settings. Results: 24% of the women who underwent ALND after NAC had pCR. In our cohort, 70% of ALNDs in patients with ypN0 were performed in non-academic institutions. Age 40-54 years, low comorbidity score and lower socioeconomic status were also associated with higher rates of ALND for ypN0 cases. Patients with hormone receptor positive/Her 2 negative tumors and tumors of low/intermediate grade were more likely to undergo ALND. All associations p<0.05. A trend toward minimally invasive axillary staging is noted after 2013 through 2015, when the results from the ACOSOG Z1071 trial were made available, with a 10% decrease in the number of ALNDs performed. Conclusions: In our study, over 24% of patients with clinically positive nodes treated with NAC were found to be pN0 at the time of ALND. Specific patient, tumor and treatment facility characteristics were associated with clinical practice variation in the use of SLNB following NAC. Overcoming barriers to translation of trial findings into routine practice may result in better outcomes for breast cancer patients.
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