Russian Journal of OncologyRussian Journal of OncologyРоссийский онкологический журнал1028-99842412-9119Eco-Vector4296210.18821/1028-9984-2018-23-3-4-116-119ArticlesСтатьиResearch ArticleBIOPSY OF SIGNAL LYMPHATIC NODULES IN PATIENTS WITH BREAST CANCER AFTER NEOAVARIANT CHEMOTHERAPYБИОПСИЯ СИГНАЛЬНЫХ ЛИМФАТИЧЕСКИХ УЗЛОВ У БОЛЬНЫХ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ ПОСЛЕ НЕОАДЪЮВАНТНОЙ ХИМИОТЕРАПИИBit-SavaElena M.Бит-СаваЕлена Михайловна

MD, PhD, DSc, head of the departmrnt of oncological surgical methods of treatment (tumors of bones, skin, soft tissues and breast), Saint-Petersburg Clinical Scientific and Practical Center of Specialized Medical Assistance (Oncological), 197758, Saint-Petersburg, Russian Federation; Professor of the Department of Oncology, Pediatric Oncology and Radiation Therapy, St. Petersburg Pediatric University, Russian Federation

доктор медицинских наук, заведующая отделением онкологических хирургических методов лечения (опухолей костей, кожи, мягких тканей и молочной железы) Клинического научно-практического онкологического центра специализированных видов медицинской помощи, профессор кафедры онкологии, детской онкологии и лучевой терапии Санкт-Петербургского педиатрического университета

bit-sava@mail.ruAnchabadzeM. GАнчабадзеМ. ГMonogarovaM. AМоногароваМ. АMoiseenkoV. MМоисеенкоВ. МSaint-Petersburg Clinical Scientific and Practical Center of Specialized Medical Assistance (Oncological)ГБУЗ «Санкт-Петербургский клинический научно-практический онкологический центр»15122018233-6VOL 23, NO3-6 (2018)ТОМ 23, №3-6 (2018)11611924082020Copyright ©; 2018, Eco-VectorCopyright ©; 2018, ООО "Эко-Вектор"2018Eco-VectorООО "Эко-Вектор"https://rjonco.com/1028-9984/article/view/42962

One of the advantages of systemic cytotoxic therapy is the «transformation» of positive axillary nodes into negative nodes (cN+ → cN-); a similar concept is used in randomized clinical trials with «post-neoadjuvant» sentinel lymph node - pNsn. In studies of ACOSOG Z1071, SENTINA, SN FNAC, was evaluated the frequency of a false-negative result with a biopsy of the sentinel lymph node (BSLU) after neodjuvant chemotherapy. It was proved that there was no need for immunohistochemical examination of lymph nodes using the BSLU technique followed by adjuvant therapy, since the detected micrometastases did not worsen overall survival. As for patients with biopsy of signaling lymph nodes after neodjuvant chemotherapy, nowadays particular interest of prognostic in significance for micrometastases and individual tumor cells in the lymph nodes, as well as an estimate of the frequency of false-negative result.

Одним из преимуществ системной цитотоксической терапии у больных местнораспространённым раком молочной железы является «трансформация» положительного статуса подмышечных лимфоузлов в отрицательные (cN+ → cN-). Подобная концепция лежит в основе использования в рандомизированных клинических исследованиях статуса «постнеоадъювантного» сигнального лимфатического узла - pNsn. В международных исследованиях ACOSOG Z1071, SENTINA, SN FNAC была оценена частота ложнонегативного результата при биопсии сигнального лимфатического узла после неоадъювантной химиотерапии. Доказано, что при использовании методики биопсии сигнальных лимфоузлов с последующей адъювантной терапией отпадает необходимость в иммуногистохимическом исследовании лимфатических узлов, т.к. выявленные микрометастазы не ухудшают общую выживаемость. Относительно пациентов с биопсией лимфатических узлов после неоадъювантной химиотерапии особый интерес на сегодняшний день представляет прогностическое значение микрометастазов и отдельных опухолевых клеток в лимфатических узлах, а также оценка частоты ложнонегативного результата.

biopsy of the sentinel lymph nodesneoadjuvant chemotherapyindividual tumor cellsбиопсия сигнальных лимфоузловнеоадъювантная химиотерапияотдельные опухолевые клеткиWolmark N., Wang J., Mamounas E., Bryant J., Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J. Natl. Cancer Inst. Monogr. 2001; 30: 96-102. [PubMed]Bear H.D., Anderson S., Brown A., Smith R., Mamounas E.P., Fisher B., Margolese R., Theoret H., Soran A., Wickerham D.L. et al. The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protoco l B-27. J. Clin. Oncol. 2003; 21: 4165-74. [PubMed]Fisher B., Brown A., Mamounas E., Wieand S., Robidoux A., Margolese R.G., Cruz A.B., Fisher E.R., Wickerham D.L., Wolmark N. et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J. Clin. Oncol. 1997; 15: 2483-93. [PubMed]van der Hage J.A., van de Velde C.J., Julien J.P., Tubiana-Hulin M., Vandervelden C., Duchateau L. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J. Clin. Oncol. 2001; 19: 4224-37. [PubMed]Tiezzi D.G., Andrade J.M., Marana H.R., Zola F.E., Peria F.M. Breast conserving surgery after neoadjuvant therapy for large primary breast cancer. Eur. J. Surg. Oncol. 2008; 34: 863-7. [PubMed]Kuerer H.M., Sahin A.A., Hunt K.K., Newman L.A., Breslin T.M., Ames F.C., Ross M.I., Buzdar A.U., Hortobagyi G.N., Singletary S.E. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann. Surg. 1999; 230: 72-8.[PMC free article] [PubMed]Baselga J., Bradbury I., Eidtmann H., Di Cosimo S., de Azambuja E., Aura C., Gómez H., Dinh P., Fauria K., Van Dooren V. et al. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet. 2012; 379: 633-40. [PubMed]Rouzier R., Extra J.M., Klijanienko J., Falcou M.C., Asselain B., Vincent-Salomon A., Vielh P., Bourstyn E. Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J. Clin. Oncol. 2002; 20: 1304-10. [PubMed]Xing Y., Foy M., Cox D.D., Kuerer H.M., Hunt K.K., Cormier J.N. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br. J. Surg. 2006; 93: 539-46. [PubMed]Mamounas E.P., Brown A., Anderson S., Smith R., Julian T., Miller B., Bear H.D., Caldwell C.B., Walker A.P., Mikkelson W.M. et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J. Clin. Oncol. 2005; 23: 2694-702. [PubMed]Shen J., Gilcrease M.Z., Babiera G.V., Ross M.I., Meric-Bernstam F., Feig B.W., Kuerer H.M., Francis A., Ames F.C., Hunt K.K. Feasibility and accuracy of sentinel lymph node biopsy after preoperative chemotherapy in breast cancer patients with documented axillary metastases. Cancer. 2007; 109: 1255-63. [PubMed]Classe J.M., Bordes V., Campion L., Mignotte H., Dravet F., Leveque J., Sagan C., Dupre P.F., Body G., Giard S. Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer: results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study. J. Clin. Oncol. 2009; 27: 726-32. [PubMed]Rubio I.T., Aznar F., Lirola J. Peg V., Xercavins J. Intraoperative assessment of sentinel lymph nodes after neoadjuvant chemotherapy in patients with breast cancer. Ann. Surg. Oncol. 2010; 17: 235-9. [PubMed]Brady E.W. Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer. Breast J. 2002; 8: 97-100. [PubMed]van Deurzen C.H., Vriens B.E., Tjan-Heijnen V.C., van der Wall E., Albregts M., van Hilligersberg R., Monninkhof E.M., van Diest P.J. Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients: a systematic review. Eur. J. Cancer. 2009; 45: 3124-30. [PubMed]van der Heiden-van der Loo M., de Munck L., Sonke G.S., van Dalen T., van Diest P.J., van den Bongard H.J., Peeters P.H., Rutgers E.J. Population based study on sentinel node biopsy before or after neoadjuvant chemotherapy in clinically node negative breast cancer patients: Identification rate and influence on axillary treatment. Eur. J. Cancer. 2015; 51: 915-21. [PubMed]Boughey J.C., Suman V.J., Mittendorf E.A., Ahrendt G.M., Wilke L.G., Taback B., Leitch A.M., Kuerer H.M., Bowling M., Flippo-Morton T.S. et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013; 310: 1455-61. [PMC free article] [PubMed]Kuehn T., Bauerfeind I., Fehm T., Fleige B., Hausschild M., Helms G., Lebeau A., Liedtke C., von Minckwitz G., Nekljudova V. et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013; 14: 609-18. [PubMed]Boileau J.F., Poirier B., Basik M., Holloway C.M., Gaboury L., Sideris L., Meterissian S., Arnaout A., Brackstone M., McCready D.R. et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J. Clin. Oncol. 2015; 33: 258-64. [PubMed]Hansen N.M., Grube B., Ye X., Turner R.R., Brenner R.J., Sim M.S., Giuliano A.E. Impact of micrometastases in the sentinel node of patients with invasive breast cancer. J Clin Oncol. 2009; 27: 4679-84. [PubMed]Cserni G., Gregori D., Merletti F., Sapino A., Mano M.P., Ponti A., Sandrucci S., Baltás B., Bussolati G. Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg. 2004; 91: 1245-52. [PubMed]de Boer M., van Deurzen C.H., van Dijck J.A., Borm G.F., van Diest P.J., Adang E.M., Nortier J.W., Rutgers E.J., Seynaeve C., Menke-Pluymers M.B. et al. Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med. 2009; 361:653-63. [PubMed]Leidenius M.H., Vironen J.H., Heikkilä P.S., Joensuu H. Influence of isolated tumor cells in sentinel nodes on outcome in small, node-negative (pT1N0M0) breast cancer. Ann Surg Oncol. 2010; 17: 254-62. [PubMed]Montagna E., Viale G., Rotmensz N., Maisonneuve P., Galimberti V., Luini A., Intra M., Veronesi P., Mazzarol G., Pruneri G. et al. Minimal axillary lymph node involvement in breast cancer has different prognostic implications according to the staging procedure. Breast Cancer Res Treat. 2009; 118: 385-94. [PubMed]Hunt K.K., Ballman K.V., McCall L.M., Boughey J.C., Mittendorf E.A., Cox C.E., Whitworth P.W., Beitsch P.D., Leitch A.M., Buchholz T.A. et al. Factors associated with local-regional recurrence after a negative sentinel node dissection: results of the ACOSOG Z0010 trial. Ann. Surg. 2012; 256: 428-36. [PubMed]Edge S.B., Byrd D.R., Compton C.C., Fritz A.G. AJCC cancer staging manual, Seven Edition. New York, Springer. 2010.Diaz-Botero S., Espinosa-Bravo M., Rodrigues Gonçalves V., Esgueva-Colmenarejo A., Peg V., Perez J., Cortes J. Rubio I.T. Complete Axillary Response In Breast Cancer Patients After Neoadjuvant Treatment Correlates With Overall Survival. Ann. Surg. Oncol. 2015; 22: S15-S18.Isabel T. Rubio. Sentinel lymph node metastasis after neoadjuvant treatment in breast cancer: Any size matters? World J. Clin. Oncol. 2015 Dec; 10; 6 (6): 202-6.