Stellenwert der Sentinel-Node-Biopsie im Rahmen neoadjuvanter Therapiekonzepte beim Mammakarzinom: Überblick und aktuelles Studienkonzept

Zusammenfassung

Die Sentinel-Node-Biopsie (SNB) ist beim primär operierten Mammakarzinom als axilläre Stagingmaßnahme fest etabliert. Für Patientinnen, die eine primär systemische Therapie (PST) erhalten, wird die Datenlage für die Zuverlässigkeit der SNB als unsicher eingestuft. Daher wird bei diesen Patientinnen nach wie vor die klassische Axilladissektion (ALD) zur Sicherung der lokalen Kontrolle empfohlen. Etwa 40 % der Frauen, die eine PST erhalten, weisen einen negativen Nodalstatus auf und werden durch die Ausräumung der axillären Lymphknoten übertherapiert. Bei diesen Patientinnen wird der Vorteil der neoadjuvanten Therapie (Erhöhung der Rate an brusterhaltenden Operationen) durch den Nachteil einer erhöhten Schulter-Arm-Morbidität „erkauft“. Aus diesem Grunde erscheint es notwendig, die Wertigkeit der SNB im Rahmen neoadjuvanter Therapiekonzepte in einem prospektiven Studienansatz zu untersuchen. In dem vorliegenden Artikel sollen die aktuelle Datenlage zu der Thematik dargestellt und theoretische Fallstricke für die SNB im Rahmen eines neoadjuvanten Therapieplanes erörtert werden. Aus der Diskussion wird ein Studienkonzept (SENTINA-Studie) abgeleitet, nach dem die anstehenden Fragestellungen zielgerichtet untersucht werden können.

Abstract

Sentinel node biopsy (SNB) is a routinely established method for axillary staging in primary breast cancers. For patients undergoing primary systemic therapy (PST) the data on the reliability of SNB have been assessed as insufficient in international consensus recommendations (DGS, AGO). Thus, axillary dissection is still recommended in those patients to obtain local control. About 40 % of the patients receiving PST have a nodal negative axillary lymph node status and will be overtreated if they undergo classical axillary dissection. These patients accept the increased risk of shoulder arm morbidity in return for the benefits of PST (higher rate of breast conserving therapy). For that reason it is essential to analyze the role of SNB in neoadjuvant study concepts in a prospective setting. This report deals with the current data on this topic and elucidates theoretical pitfalls in the context of a neoadjuvant therapy plan. From this discussion a prospective trial (SENTINA = SENTInel node biopsy after NeoAdjuvant chemotherapy) emerges, which specifically addresses the questions at issue.

Schlüsselwörter

Sentinel‐Node‐Biopsie - primär systemische Chemotherapie - Mammakarzinom

Key words

Sentinel node biopsy - primary systemic chemotherapy - breast cancer

Literatur

• 1 Kuehn T, Bembenek A, Decker T, Munz D L, Sautter-Bihl M L, Untch M, Wallwiener D. Consensus Committee of the German Society of Senology. A concept for the clinical implementation of sentinel lymph node biopsy in patients with breast carcinoma with special regard to quality assurance.  Cancer. 2005;  103 451-461
• 2 Lyman G L, Giuliano A E, Somerfield M R, Benson I IIAIB, Bodurka D C, Burstein H J, Cochran A J, Cody I IIHS, Edge S B, Galper S, Hayman J A, Kim T Y, Perkins C L, Podoloff D A, Sivasubramaniam V H, Turner R R, Wahl R, Weaver D L, Wolff A C, Winer E P. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.  J Clin Oncol. 2005;  23 7703-7720
• 3 Wolmark 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 Monographs. 2001;  30 96-102
• 4 Gianni L, Baselga J, Eiermann W. et al . First report of the European Cooperative Trial in operable breast cancer (ECTO): Effects of primary systemic therapy (PST) on local-regional disease.  Proc ASCO. 2002;  21 abstr 132
• 5 Kim T, Giuliano A E, Lyman G H. Lymphatic mapping and sentinel lymph node biopsy in early stage breast carcinoma: a metaanalysis.  Cancer. 2006;  106 4-6
• 6 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;  93 539-546
• 7 Mamounas E P. Sentinel lymph node biopsy after neoadjuvant systemic therapy.  Surg Clin North Am. 2003;  83 931-942
• 8 Nason K S, Anderson B O, Byrd D R, Dunnwald L K, Eary J F, Mankoff D A. et al . Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma.  Cancer. 2000;  89 2187-2194
• 9 Fernandez A, Cortes M, Benito E, Azpeitia D, Prieto L, Moreno A. et al . Gamma probe sentinel node localization and biopsy in breast cancer patients treated with a neoadjuvant chemotherapy scheme.  Nucl Med Commun. 2001;  22 361-366
• 10 Tafra L, Verbanac K M, Lannin D R. Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer.  Am J Surg. 2001;  182 312-315
• 11 Brady E W. Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer.  Breast J. 2002;  8 97-100
• 12 Stearns V, Ewing C A, Slack R, Penannen M F, Hayes D F, Tsangaris T N. Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer.  Ann Surg Oncol. 2002;  9 235-242
• 13 Piato J R, Barros A C, Pincerato K M, Sampaio A P, Pinotti J A. Sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy. A pilot study.  Eur J Surg Oncol. 2003;  29 118-120
• 14 Balch G C, Mithani S K, Richards K R, Beauchamp R D, Kelley M C. Lymphatic mapping and sentinel lymphadenectomy after preoperative therapy for stage II and III breast cancer.  Ann Surg Oncol. 2003;  10 616-621
• 15 Haid A, Koeberle-Wuehrer R, Offner F, Jasarevic Z, Fritzsche H, Zimmermann G. Clinical usefulness and perspectives of sentinel node biopsy in the management of breast cancer.  Chirurg. 2003;  74 657-664
• 16 Schwartz G F, Meltzer A J. Accuracy of axillary sentinel lymph node biopsy following neoadjuvant (induction) chemotherapy for carcinoma of the breast.  Breast J. 2003;  9 374-379
• 17 Reitsamer R, Peintinger F, Rettenbacher L, Prokop E. Sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy.  J Surg Oncol. 2003;  84 63-67
• 18 Aihara T, Munakata S, Morino H, Takatsuka Y. Feasibility of sentinel node biopsy for breast cancer after neoadjuvant endocrine therapy: a pilot study.  J Surg Oncol. 2004;  85 77-81
• 19 Shimazu K, Tamaki Y, Taguchi T, Akazawa K, Inoue T, Noguchi S. Sentinel lymph node biopsy using periareolar injection of radiocolloid for patients with neoadjuvant chemotherapy-treated breast carcinoma.  Cancer. 2004;  100 2555-2561
• 20 Hauschild M, Thomas A, Maza S, Kuemmel S, Fischer T, Mallman P. et al . Sentinel node biopsy in breast cancer after neoadjuvant therapy.  J Clin Oncol. 2004;  22 691 (Abstract)
• 21 Patel N A, Piper G, Patel J A, Malay M B, Julian T B. Accurate axillary nodal staging can be achieved after neoadjuvant therapy for locally advanced breast cancer.  Am Surg. 2004;  70 696-699
• 22 Kang S H, Kim S K, Kwon Y, Kang H S, Kang J H, Ro J. et al . Decreased identification rate of sentinel lymph node after neoadjuvant chemotherapy.  World J Surg. 2004;  28 1019-1024
• 23 Tio J, Buehner M, Wulfing P, Parchent H, Volkholz H, Schulze W. et al .Sentinel lymph node biopsy after primary systemic therapy of locally advanced breast cancer. Proceedings of the 27th Annual San Antonio Breast Cancer Symposium, San Antonio, TX. http://www.abstracts2view.com/sabcs/index.php [January 2005] 2004
• 24 Lang J E, Esserman L J, Ewing C A, Rugo H S, Lane K T, Leong S P. et al . Accuracy of selective sentinel lymphadenectomy after neoadjuvant chemotherapy: effect of clinical node status at presentation.  J Am Coll Surg. 2004;  199 856-862
• 25 Shen J, Mirza N Q, Gilcrease M, Babiera G V, Ross M I, Ames F C. et al .Feasibility and accuracy of sentinel lymph node biopsy following neoadjuvant chemotherapy in breast cancer patients with cytologically proven axillary metastases. Proceedings of the 27th Annual San Antonio Breast Cancer Symposium, San Antonio, TX. http://www.abstracts2view.com/sabcs/index.php [January 2005] 2004
• 26 Kinoshita T, Fukutomi T, Akashi S, Shimizu C, Ando M, Katsumata N. et al .Sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer. Proceeding of the 27th Annual San Antonio Breast Cancer Symposium, San Antonio, TX. http://www.abstracts2view.com/sabcs/index.php [January 2005] 2004
• 27 Bonardi S, Bottini A, Brizzi M P, Allevi G, Aguggini S, Generali D. et al .Role of sentinel lymph node mapping in human breast cancer after primary chemotherapy. Proceedings of the 27th Annual San Antonio Breast Cancer Symposium, San Antonio, TX. http://www.abstracts2view.com/sabcs/index.php [January 2005] 2004
• 28 Jinno H, Ikeda T, Kitajima M, Fujii H, Mukai M. Keio Analysis of sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy. http://www.abstracts2view.com/sabcs05/Abstract 1007
• 29 Kinoshita T, Fukutomi T, Akashi-Tanaka S, Terada K, Takasugi M, Shimizu C, Ando M, Katsumata N, Fujiwara Y. Sentinel lymph node biopsy for breast cancer patients with clinically negative axillary lymph nodes after neoadjuvant chemotherapy. http://www.abstracts2view.com/sabcs05/Abstract 1008
• 30 Kuehn T, Vogl F D, Helms G, Pueckler S V, Schirrmeister H, Strueber R. et al . Sentinel-node-biopsy for axillary staging in breast cancer: results from a large prospective German multi-institutional trial.  Eur J Surg Oncol. 2004;  30 252-259
• 31 Khan A, Sabel M S, Nees A, Diehl K M, Cimmino V M, Kleer C G, Schott A F, Hayes D F, Chang A E, Newman L A. Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel.  Ann Surg Oncol. 2005;  12 697-704
• 32 Intra M, Triro G, Viale G, Rotmensz N, Gentilizi O D, Soteldo J, Galimberti V, Veronesi P, Luini A, Paganelli G, Veronesi U. Second biopsy of axillary sentinel lymph node for reappearing breast cancer after previous sentinel lymph node biopsy.  Ann Surg Oncol. 2005;  12 895-899
• 33 Salmon R J, Bouillet T H, Lewis J S, Clough K B. Recurrence in the axilla after sentinel lymph node biopsy for breast cancer.  Eur J Surg Oncol. 2002;  28 199
• 34 Blanchard D K, Donohue J H, Reynolds C, Grant C S. Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer.  Arch Surg. 2003;  138 482-487
• 35 Loza J, Colo F, Nadal J, Viniegra M, Chacon R. Axillary recurrence after sentinel node biopsy for operable breast cancer.  Eur J Surg Oncol. 2002;  28 897-898
• 36 Chung M A, Steinhoff M M, Cady B. Clinical axillary recurrence in breast cancer patients after a negative sentinel node biopsy.  Am J Surg. 2002;  184 310-314
• 37 Roumen R M, Kuijt G P, Liem I H, van Beek M W. Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissection.  Br J Surg. 2001;  88 1639-1643
• 38 Estourgie S H, Nieweg O E, Valdes-Olmos R A. et al . Eight false negative sentinel node procedures in breast cancer: what went wrong?.  Eur J Surg Oncol. 2003;  29 336-340
• 39 Yen T W, Mann G N, Lawton T J, Livingston R B, Anderson B O. An axillary recurrence of breast cancer following a negative sentinel lymph node biopsy.  Breast J. 2003;  9 234-236
• 40 Reitsamer R, Peintinger F, Prokop E. et al . Sentinel lymph node biopsy alone without axillary lymph node dissection - follow up of sentinel lymph node negative breast cancer patients.  Eur J Surg Oncol. 2003;  29 221-223
• 41 Badgwell B D, Povoski S P, Abdessalam S F. et al . Patterns of recurrence after sentinel lymph node biopsy for breast cancer.  Ann Surg Oncol. 2003;  10 376-380
• 42 Giuliano A E, Haigh P I, Brennan M B. et al . Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer.  J Clin Oncol. 2000;  18 2553-2559
• 43 Dessureault S, Dupont E, Shons A. et al . Early results of breast cancer lymphatic mapping from the H. Lee Moffit Cancer Center: no axillary recurrences in breast cancer patients after a negative sentinel lymph node biopsy.  Breast Cancer Res Treat. 2000;  64 26
• 44 Kühn T. Konsensuspanel der Dt. Gesellschaft für Senologie . Sentinel-Node-Biopsie beim Mammakarzinom: Interdisziplinär abgestimmter Konsensus der Deutschen Gesellschaft für Senologie für eine qualitätsgesicherte Anwendung in der klinischen Routine.  Geburtsh Frauenheilk. 2003;  63 835-840