• J M Simons, M L M A van Pelt, Marinelli A W K S AWKS Department of Surgical Oncology, Haaglanden Medical Centre, The Hague, the Netherlands., M E Straver, A M Zeillemaker, L M Pereira Arias-Bouda, T J A van Nijnatten, L B Koppert, K K Hunt, M L Smidt, Luiten E J T EJT Department of Surgical Oncology, Amphia Hospital, Breda, the Netherlands., and C C van der Pol.
• Department of Surgical Oncology, Erasmus Medical Centre Rotterdam, Rotterdam, the Netherlands.
• Br J Surg. 2019 Nov 1; 106 (12): 1632-1639.

BackgroundMarking the axilla with radioactive iodine seed and sentinel lymph node (SLN) biopsy have been proposed for axillary staging after neoadjuvant systemic therapy in clinically node-positive breast cancer. This study evaluated the identification rate and detection of residual disease with combined excision of pretreatment-positive marked lymph nodes (MLNs) together with SLNs.MethodsThis was a multicentre retrospective analysis of patients with clinically node-positive breast cancer undergoing neoadjuvant systemic therapy and the combination procedure (with or without axillary lymph node dissection). The identification rate and detection of axillary residual disease were calculated for the combination procedure, and for MLNs and SLNs separately.ResultsAt least one MLN and/or SLN(s) were identified by the combination procedure in 138 of 139 patients (identification rate 99·3 per cent). The identification rate was 92·8 per cent for MLNs alone and 87·8 per cent for SLNs alone. In 88 of 139 patients (63·3 per cent) residual axillary disease was detected by the combination procedure. Residual disease was shown only in the MLN in 20 of 88 patients (23 per cent) and only in the SLN in ten of 88 (11 per cent), whereas both the MLN and SLN contained residual disease in the remainder (58 of 88, 66 per cent).ConclusionExcision of the pretreatment-positive MLN together with SLNs after neoadjuvant systemic therapy in patients with clinically node-positive disease resulted in a higher identification rate and improved detection of residual axillary disease.© 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

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