Sentinel lymph node biopsy should be considered for clinically node-negative breast cancer regardless of BRCA1/2 mutation status

Xin Huang; Jia-Qi Liu; Yi-Dong Zhou; Ying Xu; Chang Chen; Xiang Wang; Xi Cao; Ru Yao; Qiang Sun

doi:10.21037/atm-20-5996

Sentinel lymph node biopsy should be considered for clinically node-negative breast cancer regardless of BRCA1/2 mutation status

Ann Transl Med. 2020 Sep;8(18):1183. doi: 10.21037/atm-20-5996.

Authors

Xin Huang¹, Jia-Qi Liu², Yi-Dong Zhou¹, Ying Xu¹, Chang Chen¹, Xiang Wang², Xi Cao¹, Ru Yao¹, Qiang Sun¹

Affiliations

¹ Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China.
² Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: BRCA1/2 mutations lead to an elevated risk of breast cancer. None involved in whether BRCA1/2 mutation status will affect the first decision-making of sentinel lymph node (SLN) biopsy or not for clinically node-negative breast cancer. We retrospectively investigated whether BRCA1/2 mutation status influenced SLN involvement rate and survival outcomes after sentinel lymph node biopsy (SLNB) for Chinese clinically node-negative breast cancer patients.

Methods: Patients who underwent SLNB at initial were enrolled and divided according to BRCA1/2 mutation status. Germline DNA for BRCA1/2 testing was derived from blood samples. SLN involvement rate and clinicopathological characteristics were analyzed using the Chi-square test. Kaplan-Meier univariate and multivariate Cox regression analysis was performed to compare survival between groups.

Results: According to BRCA1/2 mutation test criteria, 156 Chinese women receiving initial SLNB with clinically node-negative breast cancer were selected-thirty-one patients identified as BRCA1/2 mutation carriers and 102 as non-carriers were enrolled. Non-carriers seemed to be with a more advanced TNM stage (P<0.01) compared to the non-carrier group. Once SLN involved, the patient will receive axillary lymph node dissection in which BRCA1/2 mutation did not increase the rate (P=0.73). Disease-free survival (DFS) (P=0.48) and recurrence-free survival (RFS) (P=0.79) are comparable between groups, even after adjustment for clinicopathological characteristics, systemic treatment, and surgical management of breast [DFS, hazard ratio (HR) =1.63, confidence interval (CI): 0.48-5.54, P=0.43; RFS, HR =0.75, CI: 0.14-3.89, P=0.73].

Conclusions: SLNB should be considered for clinically node-negative breast cancer regardless of BRCA1/2 status.

Keywords: BRCA1/2 mutation; Sentinel lymph node biopsy (SLNB); clinically node-negative breast cancer; sentinel lymph node involvement rate (SLN involvement rate); survival.