I bring up this case only because I'm getting mild pushback from surgeons about blanket applying no RT to any patient who would have qualified for B51. Agree with no RT, but have a surgeon questioning this particular scenario (mastectomy with SLNB only) without the final publication of B51. Would your opinions change in say an ER-positive patient who didn't get dual tracer and <3SLN removed?
Fair point.
When we have a patient with cN1 disease, scheduled to undergo neoadjuvant treatment, our radiologists comfirm cN1 with an ultrasound-guided-biopsy of the node prior to systemic treatment. They also deposit a clip in the node. If the patient achieves ycN0 on neoadjuvant treatment, we can the verify on the SLNB-specimen if the initially involved LN was actually removed too, by looking for the clip.
This will surely not solve the issue of "was that the only affected node?", but it will rule out uncertainties, that the initially affected node was removed during SLNB.
The Sentina trial looked into a similar question, published more than 10 years ago.
Brustkrebs Deutschland, German Society for Senology, German Breast Group.
pubmed.ncbi.nlm.nih.gov
Patients with cN1 disease who convered to cN0 after neoadjuvant chemotherapy, received SLNB, followed by axillary lymph node resection (regardless of the SLNB result), this was the Arm C of the trial.
226 patients had a successful SLNB showing ypN0 in the sentinel nodes (median number of removed nodes: 2).
14.2% of those 226 patients (32 patients) actually had positive nodes in the rest of the axilla.
