ABSTRACT
Introduction: Axillary dissection is increasingly less indicated for axillary evaluation of patients with breast cancer and clinically negative axilla. This study evaluated the application of sentinel lymph node in patients with clinical axillary remission after neoadjuvant chemotherapy. Methods: Prospective study carried out from December 2017 to July 2018, at the Liga Norte Riograndense Contra o Cancer. We considered 24 patients who had a positive axilla and after neoadjuvant chemotherapy had clinical axillary remission (ypN0). Only patients with a strongly positive status during physical examination were included, and biopsy and ultrasound examinations were not required to confirm axillary disease. The dual-tracer technique of sentinel lymph node biopsy followed by axillary dissection was used. Results: The accuracy of the sentinel lymph node in patients with clinical axillary remission was 91.7%, with a false negative rate of 13.3% (2/24). It was observed that 66.6% of patients were stage I after chemotherapy and 13 patients with negative sentinel lymph node biopsy no longer had axillary disease. During the sentinel lymph node biopsy procedure, 16 patients (79.1%) had only 1 sentinel lymph node removed. Conclusions: For patients with clinical axillary remission after neoadjuvant chemotherapy, sentinel lymph node biopsy has been included in clinical practice, reducing the indications for axillary dissection and, consequently, its morbidity. The dual-agent mapping technique of sentinel lymph node biopsy and a sample of 3 lymph nodes at surgery decrease false-negative rates and make the procedure safer.
ABSTRACT
Introduction: The proper selection of patients for sentinel lymph node biopsy is essential and depends on the evaluation of the patient's prediction for lymph node involvement and an evaluation of the accuracy of the clinical examination. Objective: This study aimed to evaluate the axillary contents of 102 breast cancer patients with tumors between 3 and 5 centimeters who underwent axillary dissection between January 2010 and December 2013. Methods: The data were categorized according to positive or negative axillary clinical evaluation and positive or negative anatomopathological evaluation. Results: The value for positive predictive values for physical examination was 83.5% and the negative predictive value was 34.88%. In addition, axillary physical examination showed 63.6% sensitivity and 60% specificity. Most patients with axillary involvement in the anatomopathological evaluation correlated with tumor grade, size, location and angiolymphatic invasion. Conclusion: It is believed that a better evaluation of the prediction of lymph node involvement, considering some clinicopathological risk factors in patients with suspicious lymph nodes, should be performed to aid the preoperative study of the axilla and the axillary approach screening
Introdução: Atualmente, precisamos selecionar adequadamente as pacientes a serem submetidas à biópsia de linfonodo sentinela. Para isso, são imprescindíveis a avaliação da predição daquele paciente acerca do comprometimento linfonodal e a avaliação da acurácia do exame clínico. Objetivo: O presente estudo teve como objetivo avaliar o conteúdo axilar de pacientes portadoras de câncer de mama com tumores entre três e cinco centímetros submetidas ao esvaziamento axilar entre 2010 e 2013, por meio da análise de 102 prontuários. Métodos: Os dados foram categorizados segundo a avaliação clínica axilar positiva ou negativa e a avaliação anatomopatológica positiva ou negativa. Resultados: Observaram-se valor preditivo positivo do exame físico de 83,5% e preditivo negativo de 34,88%. O exame físico axilar mostrou sensibilidade de 63,6% e especificidade de 60%. A maioria das pacientes com comprometimento axilar no anatomopatológico mostrou correlação com o grau tumoral, tamanho, localização e invasão angiolinfática. Conclusão: Acredita-se que uma melhor avaliação quanto à predição do comprometimento linfonodal, levando em consideração alguns fatores clinicopatológicos de risco nas pacientes com linfonodos suspeitos, deve ser feita como auxílio no estudo pré-operatório da axila e triagem no tocante à abordagem axilar