Journal de la Faculté de Médecine
Volume 1, Numéro 1, Pages 13-19

Biopsie Du Ganglion Sentinelle Après Chimiothérapie Néoadjuvante Dans Le Cancer Du Sein

Auteurs : Brahmi Khadidja . Seddiki M'hamed Mohamed Salaheddine . Boukrissa Merouane .

Résumé

Introduction - Sentinel lymph node biopsy in breast infiltrating cancer is indicated for lesions not exceeding 50 mm (T1-T2) and controversial in the presence of axillary adenopathy and after neo adjuvant chemotherapy. Sentinel lymph node biopsy is assessed by an identification rate greater than 90% and a false negative rate between 5% and 10%. A lymphophilic tracer, a patented blue dye and / or a radioisotope make the identification. This study aims to investigate the feasibility of sentinel node biopsy after neo adjuvant chemotherapy in large non-inflammatory or metastatic tumors with and without axillary adenopathy. Patients and methods - This prospective study was carried out in the surgical Clinic “A” of Oran University Hospital from January 2006 to April 2009. Patients with infiltrating breast carcinoma classified T2-T3 N0-N1 M0 and treated with neo adjuvant chemotherapy were included. We have excluded recurrent or contralateral cancer, previous surgery, pregnancy, cancer in men and patent blue allergy. The sentinel lymph node was identified by patent blue; mastectomy and axillary dissection were performed. The results were studied according to lymph node status and response to chemotherapy. Results - Seventy-one patients participated in the study. The mean tumor size was 4 cm. The identification rate was 97.2% and the false negative rate was 8.6%. In patients N0, the identification rate was higher than the N1 (100% vs 95.3%). The rate of false negatives was higher in the N1 group, with no statistically significant difference (p = 0.11). In the case of a good response to chemotherapy, the rate of identification was high and the rate of false negatives was low in patients with negative lymph nodes. Conclusion - Sentinel lymph node biopsy is possible after neo adjuvant chemotherapy in locally advanced, operable, non-inflammatory and non-metastatic invasive breast cancer.

Mots clés

Breast cancer; sentinel lymph node; axillary dissection; neoadjuvant chemotherapy.