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Timing of SLN procedure should be performed 
before or after 
administration of neoadjuvant chemotherapy? 
Adune Ratanawic...
Axilla staging surgery 
Best for node negative 
patients 
Best for node positive 
patients 
Sentinel lymph node biopsy Axi...
Targeted populations 
Stage 0 Stage I Stage II Stage III Stage IV 
Node Negative 
Node Positive 
No need for SLN No need f...
Targeted populations 
Stage 0 Stage I Stage II Stage III Stage IV 
Node Negative 
Node Positive 
More benefits 
More effor...
Targeted populations 
Stage 0 Stage I Stage II Stage III Stage IV 
Node Negative 
Node Positive 
More benefits 
Node 
Nega...
Targeted populations 
Stage 0 Stage I Stage II Stage III Stage IV 
Node Negative 
Node Positive 
More benefits 
Node 
Nega...
Benefit of SLN Bx in neoadjuvant 
breast cancer patients 
•In patients who has negative node or turn 
to be negative node ...
Limitation of using SLN Bx in neoadjuvant settings 
Before neoadjuvant 
or 
After neoadjuvant
Identification rate 100% 
Negative nodes 22/52 cases = 42% 
1 progressive node during neoadjuvant 
J.L. Jones et al. / The...
After neoadjuvant 
Identification rate 81% false negative 15% 
Negative 11/36 cases = 31% 
J.L. Jones et al. / The America...
Success 82-100% 
False Negative 11 % 
After neoadjuvant 
Charfare H. et al. / BJS 2005; 92: 14–23
After neoadjuvant 
All 53 patients has 
positive node before 
neoadjuvant 
chemotherapy 
Additional 32% node 
negative cas...
The SENTINA study 
2,234 patients 
Neo-adjuvant
Neo-adjuvant 
The SENTINA study 
2,234 patients 
99% 60% 80%
The SENTINA study 
2,234 patients 
52% 14% 
Neo-adjuvant
The SENTINA study 
2,234 patients 
Neo-adjuvant 
Detection rate 60% 80% 
False negative rate 52% 14%
Sentinal LN Biopsy for Breast Cancer
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Sentinal LN Biopsy for Breast Cancer

Timing of SLN procedure should be performed before or after administration of neoadjuvant chemotherapy?
Adune Ratanawichitrasin, MD

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Sentinal LN Biopsy for Breast Cancer

  1. 1. Timing of SLN procedure should be performed before or after administration of neoadjuvant chemotherapy? Adune Ratanawichitrasin MD
  2. 2. Axilla staging surgery Best for node negative patients Best for node positive patients Sentinel lymph node biopsy Axillary lymph node dissections
  3. 3. Targeted populations Stage 0 Stage I Stage II Stage III Stage IV Node Negative Node Positive No need for SLN No need for SLN
  4. 4. Targeted populations Stage 0 Stage I Stage II Stage III Stage IV Node Negative Node Positive More benefits More efforts
  5. 5. Targeted populations Stage 0 Stage I Stage II Stage III Stage IV Node Negative Node Positive More benefits Node Negative after neo adjuvant More efforts
  6. 6. Targeted populations Stage 0 Stage I Stage II Stage III Stage IV Node Negative Node Positive More benefits Node Negative after neo adjuvant Node Negative before neo adjuvant More efforts
  7. 7. Benefit of SLN Bx in neoadjuvant breast cancer patients •In patients who has negative node or turn to be negative node after neoadjuvant •How accurate SLN Bx
  8. 8. Limitation of using SLN Bx in neoadjuvant settings Before neoadjuvant or After neoadjuvant
  9. 9. Identification rate 100% Negative nodes 22/52 cases = 42% 1 progressive node during neoadjuvant J.L. Jones et al. / The American Journal of Surgery 190 (2005) 517–520
  10. 10. After neoadjuvant Identification rate 81% false negative 15% Negative 11/36 cases = 31% J.L. Jones et al. / The American Journal of Surgery 190 (2005) 517–520
  11. 11. Success 82-100% False Negative 11 % After neoadjuvant Charfare H. et al. / BJS 2005; 92: 14–23
  12. 12. After neoadjuvant All 53 patients has positive node before neoadjuvant chemotherapy Additional 32% node negative cases Newman EA, et al. / Annals of Surgical Oncology 14(10):2946–2952
  13. 13. The SENTINA study 2,234 patients Neo-adjuvant
  14. 14. Neo-adjuvant The SENTINA study 2,234 patients 99% 60% 80%
  15. 15. The SENTINA study 2,234 patients 52% 14% Neo-adjuvant
  16. 16. The SENTINA study 2,234 patients Neo-adjuvant Detection rate 60% 80% False negative rate 52% 14%

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