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    • Evaluation of the Assessment Tools to Predict Axillary Status Postneoadjuvant Chemotherapy in Locally Advanced Breast Cancer

    Hisham Khalifa MD1, Ahmed Touny MD1 , Ihab Saad1 , Ahmed Abd elmaabood2 , Iman Hussein3 , Sherif Maamoon1
    1Department of Surgery, National Cancer Institute, Cairo University. 2Department of Medical Oncology, National Cancer Institute, Cairo University. 3Department of Patholog, National Cancer Institute, Cairo University.

    This study proposes to replace the completion axillary dissection with the confirmation of a complete pathological response to neoadjuvant chemotherapy among the axillary nodes. That response will be determined by clinical examination, US assessment of axillary lymph nodes (ALNs) and SLNB. From May 2010 to April 2012 we prospectively studied 50 women consecutively selected from among patients presented to Surgical Oncology Department, National Cancer Institute (NCI) who fulfilled the following inclusion criteria: locally advanced operable breast cancer histologically confirmed by thick needle biopsy puncture that had undergone preoperative primary systemic chemotherapy, breast cancer surgery and SLNB with immediate axillary lymphadenectomy. The clinical, sonographic and pathological response of the tumor and the axillary lymph nodes were documented, classified and correlated with each other. The response of the tumor and the axilla were correlated with various patient characteristics and analyzed. Post NACT, on sonographic assessment of the axilla, response was complete in 17 (33.3%) axillae and 34 (66.7%) axillae still showed residual metastatic disease. Complete pathological nodal response (pCR) occurred in 16 (31.4%) axillae and no pathological complete nodal response in 35 (68.9%) axillae. the sentinel lymph node was successfully identified in 39(76.5%) axillae out of 51 axillae; yielding a detection rate of about 76.5% (SLN was not identified in 12 cases. Out of 39 axillae in which SLN were identified there were 32 (82.1%) axillae showed metastatic deposits, while SLN were free of metastatic disease in 7 (17.9%) axillae by hematoxylin and eosin pathological examination. And by using the immunohistochemical examination of negative SLN all of them were also negative with absence of micro metastases, SLN was the only positive node in 9 axillae. Correlation of clinical assessment of ALN versus pathological results (considered as the gold standard) showed that the sensitivity of clinical assessment was 60.0%, specificity was 62.5%, PPV was 77.8%, NPV was 41.7% and accuracy was 60.8%, with p value (0.135). Correlation of US response of ALN versus pathological results (considered as the gold standard) showed that the sensitivity US assessment of ALN was 82.9%, specificity was 68.8%, PPV was 85.3%, NPV was 64.7%, accuracy was 78.5%, with highly significant p value <0.001 . Correlation of SLNB assessment of ALN versus pathological results (considered as the gold standard) showed that Sensitivity of SLNB was 94.1%, specificity was 100.0%, PPV was 100.0%, NPV was 71.4%, accuracy was 94.9% with highly significant p value <0.001. Conclusion: We suggest that formal ALND can be avoided post NACT in patients with LABC with cytologically proven metastatic ALN if there were complete clinical, sonographic response and negative SLNB post NACT. Key words: locally advanced Breast Cancer, sentinel Lymph node biopsy. 

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