Sentinel node biopsy following neoadjuvant chemotherapy in biopsy proven node positive breast cancer: The SN FNAC study.
Bibliographic record
Abstract
1018 Background: A significant and increasing proportion of patients (>30%) with biopsy proven node positive breast cancer will obtain a pathological complete response (pCR) in the axilla after neoadjuvant chemotherapy (NAC). If sentinel node biopsy (SNB) can accurately identify these patients, they could potentially avoid the morbidity of an axillary node dissection. The primary aim of this study is to evaluate the identification rate (IR), false negative rate (FNR) and accuracy of SNB in this setting. The accuracy of post NAC axillary ultrasound and clinical examination are evaluated as secondary endpoints. Methods: Patients with biopsy proven node positive breast cancer (T0-3, N1-2, M0) treated with NAC were eligible to participate in this multi-centre prospective trial. Following NAC, axillary ultrasound and clinical examination results were obtained. At time of surgery, all participants underwent both a SNB and a completion node dissection. A SNB IR greater than 90% and a FNR of less than 10% were pre-determined as being optimal. Results: From September 2009 to December 2012, 153 patients were accrued to the study. 7 patients were not eligible and 5 patients had not yet undergone surgery at the time of analysis. Axillary pCR rate = 34.0% (48/141). SNB IR = 87.2% (123/141), 95% CI [81.7%-92.7%] and FNR = 9.9% (8/81), 95% CI [3.4%-16.4%]. If only one sentinel node was removed, FNR = 19.0%(4/21); if there were 2 or more sentinel nodes, FNR = 6.6% (4/61) (p < 0.0001). Accuracy of SNB, axillary ultrasound and clinical examination were 93.5%, 63.2%, and 45.5% respectively. Conclusions: SNB following NAC in biopsy proven node positive breast cancer is associated with a suboptimal IR. FNR (less than 10%) and accuracy of SNB in this study are comparable to that of patients that present with clinically negative nodes. The FNR decreases when more than one sentinel node is identified. However, in an era where regional nodal radiation is increasingly used, the relevance of leaving residual disease in the undissected axilla after NAC is unknown and remains to be investigated. Clinical trial information: NCT00909441.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".