ročník 11,2003 č.4

Sentinel Node Biopsy and Neoadjuvant Chemotherapy in Patients with Advanced Breast Cancer

Gatek J., Bakala J., Duben J., Hnatek L., Skopal L.,

Department of Surgery Atlas Hospital Zlin,
Department of Nuclear Medicine Bata Hospital Zlin,
Czech Republic


Neoadjuvant chemotherapy was introduced in order to allow removal of locally advanced breast cancer and to enable locoregional control of the disease. Neodjuvant chemotherapy also can convert mastectomy to breast conservation therapy where mastectomy was the only solution. Accurate staging of axillary lymph nodes is very important especially before the initiation of the treatment and it is very difficult. Metastasis can be accurately determined by histology examination of axillary nodes only. That is why assessment of neoadjuvant therapy is inaccurate and therefore determination of benefits to the patient is not straightforward. Sentinel node biopsy performed before preoperative chemotherapy can improve axillary node staging and allows observation of the effectiveness of the chemotherapy. The status of nonsentinel nodes can be derived from metastasis size in sentinel node. Disappearance of presumptive metastasis in nonsentinel nodes can result from neoadjuvant therapy. Sentinel node can be negative after 3-4th cycle of the chemotherapy. In this group of patients axillary dissection could be avoided. This is another benefit of the sentinel node biopsy. The aim of this study is to determine the effect of the chemotherapy on sentinel node biopsy.


Sentinel node biopsy was performed after neoadjuvant chemotherapy in 22 patients between 1998 and 2002.Seventeen patients underwent 3-4 cycles chemotherapy and five neoadjuvant chemotherapy with radiotherapy. Sentinel nodes were detected in 4 cases by blue dye only and in 22 cases by combination of blue dye and radiocolloid.


Medium size of tumor was 4,1 cm, /maximum 9,1 cm, minimum 2,0 cm, median 4,0cm /. Mastectomy was performed 19x, conservative surgery 3x. The number of examined sentinel nodes was 48, medium 2,2 /median 2 /. 269 of axillary nodes was explored /medium 12,3 median 11 / Patients with positive sentinel node only were 7. Cases with both positive sentinel and nonsentinel nodes were 8. False negative sentinel node was only in one case.


We have not seen differences in sentinel node biopsy after preoperative chemotherapy. Sentinel node biopsy can improve accuracy of breast cancer staging in patient with neoadjuvant chemotherapy and also may improve evaluation effect of neoadjuvant therapy. In certain group of patients axillary dissection may be abandoned.