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Top Line: Is there any way we can identify which women with clinically node-positive breast cancer can safely have a sentinel node biopsy without completion dissection after achieving a complete response to neoadjuvant chemo?
The Study: A report in the Annals of Surgical Oncology this week utilizes NCDB data to derive and validate a model for predicting pathologic complete response to neoadjuvant chemotherapy in women with node-positive breast cancer. The predictors? Younger age, triple-negative or HER2+ receptor status, high-grade, ductal histology, and N1 (vs N2). More than anything, response of the primary tumor was the overwhelming determinant of response in the nodes. Given that this may not be as easy to quantify prior to surgery, the other factors were used to create the predictive model. For example, a woman <50 years old with HER2(+), grade 3, cN1 ductal carcinoma with a complete clinical response at the primary site gets a max score of 15 and has over 75% chance of being pN0. Wow.
Bottom Line: Young patients with non-luminal type breast cancers that clinically respond to neoadjuvant therapy might be good candidates for sentinel node biopsy without a mandatory completion dissection.
The Study: A report in the Annals of Surgical Oncology this week utilizes NCDB data to derive and validate a model for predicting pathologic complete response to neoadjuvant chemotherapy in women with node-positive breast cancer. The predictors? Younger age, triple-negative or HER2+ receptor status, high-grade, ductal histology, and N1 (vs N2). More than anything, response of the primary tumor was the overwhelming determinant of response in the nodes. Given that this may not be as easy to quantify prior to surgery, the other factors were used to create the predictive model. For example, a woman <50 years old with HER2(+), grade 3, cN1 ductal carcinoma with a complete clinical response at the primary site gets a max score of 15 and has over 75% chance of being pN0. Wow.
Bottom Line: Young patients with non-luminal type breast cancers that clinically respond to neoadjuvant therapy might be good candidates for sentinel node biopsy without a mandatory completion dissection.
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