Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction

S. Samiei*, B. N. van Kaathoven, L. Boersma, R. W.Y. Granzier, S. Siesling, S. M.E. Engelen, L. de Munck, S. M.J. van Kuijk, R. R.J.W. van der Hulst, M. B.I. Lobbes, M. L. Smidt, T. J.A. van Nijnatten

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
7 Downloads (Pure)

Abstract

Background: Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer. Methods: All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between 2010 and 2016 were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN. Results: In total 788 patients were included, of whom 25.0% (197/788) had positive SLN. cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+ , and cT1-2N0 triple-negative patients had the lowest rate of positive SLN: 7.2–11.5%, 0–6.3%, and 2.9–6.2%, respectively. cT1-3N0 ER+HER2− and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8–41.7% and 30.4%, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.01–3.96), cT3 (OR 2.56; 95% CI 1.30–5.38), grade 3 (OR 0.44; 95% CI 0.21–0.91), and ER+HER2− subtype (OR 3.94; 95% CI 1.77–8.74) were correlated with positive SLN. Conclusions: In cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER+HER2− and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.

Original languageEnglish
Pages (from-to)3902-3909
Number of pages8
JournalAnnals of surgical oncology
Volume26
Issue number12
Early online date29 Jul 2019
DOIs
Publication statusPublished - 1 Nov 2019

Fingerprint

Neoadjuvant Therapy
Mammaplasty
Radiotherapy
Breast Neoplasms
Odds Ratio
Confidence Intervals
Regression Analysis
Sentinel Lymph Node
Mastectomy
Netherlands
Registries
Decision Making
Logistic Models
Lymph Nodes

Keywords

  • UT-Hybrid-D

Cite this

Samiei, S. ; van Kaathoven, B. N. ; Boersma, L. ; Granzier, R. W.Y. ; Siesling, S. ; Engelen, S. M.E. ; de Munck, L. ; van Kuijk, S. M.J. ; van der Hulst, R. R.J.W. ; Lobbes, M. B.I. ; Smidt, M. L. ; van Nijnatten, T. J.A. / Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer : Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction. In: Annals of surgical oncology. 2019 ; Vol. 26, No. 12. pp. 3902-3909.
@article{0f3256a888a84f118d96af621680d808,
title = "Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction",
abstract = "Background: Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer. Methods: All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between 2010 and 2016 were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN. Results: In total 788 patients were included, of whom 25.0{\%} (197/788) had positive SLN. cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+ , and cT1-2N0 triple-negative patients had the lowest rate of positive SLN: 7.2–11.5{\%}, 0–6.3{\%}, and 2.9–6.2{\%}, respectively. cT1-3N0 ER+HER2− and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8–41.7{\%} and 30.4{\%}, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95{\%} confidence interval [CI] 1.01–3.96), cT3 (OR 2.56; 95{\%} CI 1.30–5.38), grade 3 (OR 0.44; 95{\%} CI 0.21–0.91), and ER+HER2− subtype (OR 3.94; 95{\%} CI 1.77–8.74) were correlated with positive SLN. Conclusions: In cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER+HER2− and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.",
keywords = "UT-Hybrid-D",
author = "S. Samiei and {van Kaathoven}, {B. N.} and L. Boersma and Granzier, {R. W.Y.} and S. Siesling and Engelen, {S. M.E.} and {de Munck}, L. and {van Kuijk}, {S. M.J.} and {van der Hulst}, {R. R.J.W.} and Lobbes, {M. B.I.} and Smidt, {M. L.} and {van Nijnatten}, {T. J.A.}",
note = "Springer deal",
year = "2019",
month = "11",
day = "1",
doi = "10.1245/s10434-019-07643-x",
language = "English",
volume = "26",
pages = "3902--3909",
journal = "Annals of surgical oncology",
issn = "1068-9265",
publisher = "Springer",
number = "12",

}

Samiei, S, van Kaathoven, BN, Boersma, L, Granzier, RWY, Siesling, S, Engelen, SME, de Munck, L, van Kuijk, SMJ, van der Hulst, RRJW, Lobbes, MBI, Smidt, ML & van Nijnatten, TJA 2019, 'Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction', Annals of surgical oncology, vol. 26, no. 12, pp. 3902-3909. https://doi.org/10.1245/s10434-019-07643-x

Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer : Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction. / Samiei, S.; van Kaathoven, B. N.; Boersma, L.; Granzier, R. W.Y.; Siesling, S.; Engelen, S. M.E.; de Munck, L.; van Kuijk, S. M.J.; van der Hulst, R. R.J.W.; Lobbes, M. B.I.; Smidt, M. L.; van Nijnatten, T. J.A.

In: Annals of surgical oncology, Vol. 26, No. 12, 01.11.2019, p. 3902-3909.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer

T2 - Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction

AU - Samiei, S.

AU - van Kaathoven, B. N.

AU - Boersma, L.

AU - Granzier, R. W.Y.

AU - Siesling, S.

AU - Engelen, S. M.E.

AU - de Munck, L.

AU - van Kuijk, S. M.J.

AU - van der Hulst, R. R.J.W.

AU - Lobbes, M. B.I.

AU - Smidt, M. L.

AU - van Nijnatten, T. J.A.

N1 - Springer deal

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Background: Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer. Methods: All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between 2010 and 2016 were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN. Results: In total 788 patients were included, of whom 25.0% (197/788) had positive SLN. cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+ , and cT1-2N0 triple-negative patients had the lowest rate of positive SLN: 7.2–11.5%, 0–6.3%, and 2.9–6.2%, respectively. cT1-3N0 ER+HER2− and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8–41.7% and 30.4%, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.01–3.96), cT3 (OR 2.56; 95% CI 1.30–5.38), grade 3 (OR 0.44; 95% CI 0.21–0.91), and ER+HER2− subtype (OR 3.94; 95% CI 1.77–8.74) were correlated with positive SLN. Conclusions: In cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER+HER2− and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.

AB - Background: Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer. Methods: All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between 2010 and 2016 were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN. Results: In total 788 patients were included, of whom 25.0% (197/788) had positive SLN. cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+ , and cT1-2N0 triple-negative patients had the lowest rate of positive SLN: 7.2–11.5%, 0–6.3%, and 2.9–6.2%, respectively. cT1-3N0 ER+HER2− and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8–41.7% and 30.4%, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.01–3.96), cT3 (OR 2.56; 95% CI 1.30–5.38), grade 3 (OR 0.44; 95% CI 0.21–0.91), and ER+HER2− subtype (OR 3.94; 95% CI 1.77–8.74) were correlated with positive SLN. Conclusions: In cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER+HER2− and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.

KW - UT-Hybrid-D

UR - http://www.scopus.com/inward/record.url?scp=85069944044&partnerID=8YFLogxK

U2 - 10.1245/s10434-019-07643-x

DO - 10.1245/s10434-019-07643-x

M3 - Article

C2 - 31359276

AN - SCOPUS:85069944044

VL - 26

SP - 3902

EP - 3909

JO - Annals of surgical oncology

JF - Annals of surgical oncology

SN - 1068-9265

IS - 12

ER -