Is sentinel lymph node biopsy after neoadjuvant chemotherapy feasible in Chinese patients with invasive breast cancers?

Background: A wide variation in the accuracy of performance of sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy in breast cancer has been reported despite its increased use. This study aimed to be the first to evaluate the feasibility and accuracy of SLNB after neoadjuvant chemotherapy in Chinese patients with breast cancer. Methods: A review of prospectively collected data from breast cancer patients who had SLNB after prior neoadjuvant chemotherapy was performed. A combination of radiopharmaceutical 99mTc-albumin colloid (Pharmalucence, MA, USA) and Patent Blue V dye (Guerbet, France) was used to identify the SLN. SLNB was followed by standard axillary dissection in all patients. Results: A total of 365 patients received SLNB from May 1999 to April 2006. Atotal of 78 patients with neoadjuvant chemotherapy followed by SLNB were recruited. The SLN identification rate, false-negative rate and accuracy rate were 83.3, 10.3 and 73.1%, respectively. Analysis was stratified into clinical and pathological response group. Location of the tumour was also found to be an important factor in affecting the false-negative rate (P = 0.019). For upper, outer quadrant tumour, five (32.3%, out of 16) patients presented with false-negative. Patients with more sentinel lymph node harvest had higher accuracy. A total of 22 patients had three or more lymph nodes harvested, and the false-negative rate was 21.7% (5 out of 23 patients) (P = 0.00). Conclusions: The results of our study show that SLNB is feasible and applicable in Chinese patients with breast cancer with operable disease who have received neoadjuvant chemotherapy.