Sentinel node biopsy after neoadjuvant chemotherapy: A new standard for patients with axillary metastases?
Mené sur 663 femmes atteintes d'un cancer du sein de stade T0 à T4 avec envahissement ganglionnaire cN1, cet essai multicentrique évalue le taux de faux négatif associé à une biopsie des ganglions sentinelles après une chimiothérapie néoadjuvante
Large prospective studies found false-negative rates of 7% to 10% for this procedure, but recurrent cancer in the axillary nodes is seen in fewer than 1% of patients with no metastases in the SLN.1- 2 More recently, clinical trials examining the need for ALND in patients treated with lumpectomy, breast radiation, and systemic therapy who had micrometastases3 or 1 to 2 macrometastases in SLNs demonstrated no survival advantage for ALND and high rates of axillary cancer control after SLN biopsy alone.4 This reflects the fact that systemic therapy also contributes to axillary cancer control.5 In patients without evident cancer in their axilla, SLN biopsy following neoadjuvant chemotherapy (therapy delivered before surgery) is considered acceptable, largely based on retrospective studies demonstrating a high rate of finding SLNs during the operation and, after identifying the sentinel lymph node, false-negative rates similar to those seen in patients who undergo SLN biopsy before chemotherapy.6 In the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 trial, the rate of finding cancer with ALND was reduced from 57% to 41% with neoadjuvant therapy.7
JAMA , éditorial en libre accès, 2012