Timing of SLN procedure should be performed

before or after

administration of neoadjuvant chemotherapy?

Adune Ratanawichitrasin MD

Axilla staging surgery

Sentinel lymph node biopsy Axillary lymph node dissections

Best for node negative patients

Best for node positive patients

Targeted populations

Node Negative

Node Positive

Stage 0 Stage I Stage II Stage III Stage IV

No need for SLN No need for SLN

Targeted populations

Node Negative

Node Positive

Stage 0 Stage I Stage II Stage III Stage IV

More benefitsMore efforts

Targeted populations

Node Negative

Node Positive

Stage 0 Stage I Stage II Stage III Stage IV

More benefitsMore efforts

Node Negative after neo adjuvant

Neoadjuvant setting

Targeted populations

Node Negative

Node Positive

Stage 0 Stage I Stage II Stage III Stage IV

More benefitsMore efforts

Node Negative after neo adjuvant

Neoadjuvant setting

Node Negative

before neo

adjuvant

Benefit of SLN Bx in neoadjuvant breast cancer patients

•In patients who has negative node or turn

to be negative node after neoadjuvant

•How accurate SLN Bx

After neoadjuvant

Limitation of using SLN Bx in neoadjuvant settings

Before neoadjuvant

or

J.L. Jones et al. / The American Journal of Surgery 190 (2005) 517–520

Before neoadjuvant

Negative nodes 22/52 cases = 42%

1 progressive node during neoadjuvant

Identification rate 100%

After neoadjuvant

Negative 11/36 cases = 31%J.L. Jones et al. / The American Journal of Surgery 190 (2005) 517–520

Identification rate 81% false negative 15%

Success 82-100%

False Negative 11 %

After neoadjuvant

Charfare H. et al. / BJS 2005; 92: 14–23

After neoadjuvant

All 53 patients has positive node before neoadjuvant chemotherapy

Additional 32% node negative cases

Newman EA, et al. / Annals of Surgical Oncology 14(10):2946–2952

The SENTINA study2,234 patients

Design

Neo-adjuvant

Neo-adjuvantThe SENTINA study2,234 patients

Detection rate 99% 60% 80%

The SENTINA study2,234 patients

False negative rate 52% 14%

Neo-adjuvant

The SENTINA study2,234 patients

Neo-adjuvant

Detection rate 60% 80%

False negative rate 52% 14%