ppt课件-postneo-adjuvantchemoaxillarynodeissues.pptVIP

Basic Concepts Sentinel node biopsy is at least as good for axillary assessment as ALND and probably superior. Standard path evaluation for ALND yields ~ 20% false negative. SLN eval yields ~ 5% false negative. Long term follow-up of sentinel node negative patients with no ALND has recurrence rates of 1.5% or less. Survival after SLN – with adjuvant Rx is superior to Historical NSABP standard ALND – with adjuvant rx, suggesting missed + nodes in old studies and improved data on modern SLN studies. Even with + sentinel node and standard BCT Rx axillary recurrence is rare. Axillary node dissection probably provides no benefit to overall survival. Sentinel node: Next Level questions Settings: Peri- neoadjuvant chemo IBT Recurrence with prior axillary interventions Post Neo-adjuvant Chemo Axillary Node Issues Is sentinel node ID possible in this setting? Is the sentinel node concept meaningful in this setting? i.e. = Will it change therapy/ Surgery, Chemo or Rad Rx? Will a positive sentinel node imply additional positive nodes? Can ALND be avoided if SLN Negative? Should SLN BX be done pre Neoadj Rx (instead or in addition) Questions Should a positive sentinel node in the Axillary Node Dissection Group lead to more detailed study of additional nodes? Will it change Rx. If a sentinel node is positive and add levels to other nodes, + 20% pickup? If ALND “only” may miss mets. Two levels per node. SLN the Only + node ~50% It is the sentinel node “positive” by SLN protocol, remainder “negative” by standard protocol, that may be significant. May be missed if not ID. Other Issues Sentinel node count may be lower post neoadjuvant Rx What is the correlation between in breast CPR and nodal CPR. Le Bouedec, Geissler, et al2006 74 pts T1T2T3N0N1 POST neo SLN 68/74 (92%) then ALND Mets in 30/68 (44%) i.e. Neg 56% False neg 14% But if clinically neg N0 pre RX then accuracy 100% and FN 0% In 32 N1 patients accuracy 83% FN 25% Reitsamer, Peintinger, et al (2003) 30 Patients Stag