Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial

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  • dc.contributor.author Vernet-Tomás, Maria
  • dc.contributor.author Argudo Aguirre, Nuria
  • dc.contributor.author Jiménez Gómez, Marta
  • dc.contributor.author Masó, Paula
  • dc.contributor.author Miguel Palacio, Maite de
  • dc.contributor.author Martínez, Anabel
  • dc.contributor.author Vidal-Sicart, Sergi
  • dc.contributor.author Aguilar, Yolanda
  • dc.contributor.author Rubio, Lourdes
  • dc.contributor.author Valhondo, Raquel
  • dc.contributor.author Alcantara da Silva, Rodrigo
  • dc.contributor.author Arenas, Natalia
  • dc.contributor.author Pitarch-Diago, Mireia
  • dc.contributor.author Vázquez de Las Heras, Ivonne
  • dc.contributor.author Comerma Blesa, Laura, 1983-
  • dc.contributor.author Sanz, Javier
  • dc.contributor.author Algara López, Manuel-Ignacio
  • dc.contributor.author Noguera, Alicia
  • dc.contributor.author Nicolau, Pau
  • dc.date.accessioned 2024-03-06T06:58:31Z
  • dc.date.available 2024-03-06T06:58:31Z
  • dc.date.issued 2023
  • dc.description.abstract Background: Some studies suggested that the patients included in the Z0011 trial may represent patients with ultrasound-negative axillary nodes and axillary invasion diagnosed by sentinel node (SN) biopsy. Nevertheless, the National Comprehensive Cancer Network (NCCN) guidelines recommend SN mapping if 1 or 2 suspicious lymph nodes are identified on axillary ultrasound (AU). The aim of this preliminary phase of the Multimodal Targeted Axillary Surgery (MUTAS) trial was to establish the accuracy of SN mapping in patients with axillary involvement undergoing upfront surgery. Methods: Between September 2019 and March 2022, we recruited patients with biopsy-proven metastatic axillary nodes and upfront surgery from a single center. We performed SN mapping in these patients before the surgical intervention, which included axillary lymph node dissection. The biopsy-proven metastatic node, SNs and the remaining axillary nodes were excised separately. SN status was considered representative of the status of the remaining axillary nodes. We calculated the sensitivity, specificity, negative predictive value and positive predictive value of the SN, overall and in patients with palpable nodes, in those with non-palpable nodes and an AU leading to diagnosis of axillary involvement, in those with 1 or 2 suspicious nodes on AU, and in patients with a single suspicious node on AU. We evaluated clinical, imaging and pathology features as predictors of the status of the remaining axillary nodes, false-negatives, and false-positives. Results: We included 25 patients in this phase. The false-negative rate of SN mapping was 28% overall, 21.42% for patients with palpable nodes, 36.36% for patients with non-palpable nodes and an AU diagnosis of axillary involvement, 28.75% for those with 1 or 2 suspicious nodes on AU, and 15.38% in patients with a single suspicious node on AU. The negative predictive value was highest in patients with a single suspicious node on AU (75%). The only significant predictive factor was that FN showed a higher Ki67 index score. Conclusions: In this study, SN mapping was not reliable in patients with biopsy-proven metastatic axillary nodes and upfront surgery for any of the subgroups studied. Further research should elucidate the best staging pathways in these patients to avoid premature de-escalation.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Vernet-Tomás M, Argudo N, Jimenez M, Masó P, De Miguel M, Martínez A, Vidal-Sicart S, Aguilar Y, Rubio L, Valhondo R, Alcantara R, Arenas N, Pitarch M, de Las Heras IV, Comerma L, Sanz J, Algara M, Noguera A, Nicolau P. Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial. Gland Surg. 2023 Feb 28;12(2):140-51. DOI: 10.21037/gs-22-480
  • dc.identifier.doi http://dx.doi.org/10.21037/gs-22-480
  • dc.identifier.issn 2227-684X
  • dc.identifier.uri http://hdl.handle.net/10230/59332
  • dc.language.iso eng
  • dc.publisher AME Publishing
  • dc.relation.ispartof Gland Surg. 2023 Feb 28;12(2):140-51
  • dc.rights This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
  • dc.subject.keyword Breast cancer
  • dc.subject.keyword Biopsy-proven lymph nodes
  • dc.subject.keyword False-negatives
  • dc.subject.keyword Non-palpable lymph nodes
  • dc.subject.keyword Sentinel nodes (SNs)
  • dc.title Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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