Avoiding Sentinel Lymph Node Biopsy in Breast Cancer Patients After Neoadjuvant Chemotherapy
Avoiding Sentinel Lymph Node Biopsy in Breast Cancer Patients After Neoadjuvant Chemotherapy
This study evaluates whether SLNB can safely be omitted in breast cancer patients with HER2+
 or TN tumors who achieve a radiological complete response on MRI after neoadjuvant systemic
 therapy
Axillary staging in clinically node negative (cN0) breast cancer patients with neoadjuvant
 systemic therapy (NST; i.e. chemo- and immunotherapy), is preferably performed with sentinel
 lymph node biopsy (SLNB) after NST. The probability of a tumor-positive SLNB post-NST is low.
 cN0 patients with Human Epidermal growth factor Receptor 2- positive (HER2+) or triple
 negative (TN) breast cancer who achieve radiologic complete response (rCR) of the breast on
 MRI, have the lowest probability of a tumor-positive SLNB post-NST (<3%). Omitting removal of
 axillary lymph nodes in clinically node negative patients does not increase the rate of
 distant metastases nor breast cancer mortality. Performing SLNB can cause short- and
 long-term morbidity, reducing quality of life. The additional value of performing SLNB in
 patients with a very low risk of tumor-positive axillary lymph nodes should be investigated.
Inclusion Criteria:

 -  Women, aged ≥ 18 years

 -  Invasive HER2+ (HR+/-) or TN breast cancer

 -  Primary tumor (T), clinical stage T1-3

 -  Neoadjuvant systemic therapy (NST), at least 3 cycles

 -  Tumor stage assessed with breast MRI before start NST

 -  Clinically node-negative before start NST (no suspect ALNs on ultrasound and
 FGD-PET/CT, or negative cyto-/histopathology in case of suspect nodes)

 -  MRI after or during NST shows radiologic complete response

 -  Written and signed informed consent

 Exclusion Criteria:

 -  Primary tumor (T) clinical stage T4

 -  Patients without ultrasound or FDG-PET/CT pre-NST

 -  History of breast cancer ipsilateral breast

 -  Synchronous contralateral breast cancer

 -  Synchronous M1 disease