Patients with cN3b breast cancer have traditionally been considered to have advanced nodal disease. The recommended axillary management of this patient group has thus consisted of axillary lymph node dissection (ALND) with adjuvant radiation.
1 Data have shown that patients with internal mammary lymph node metastases are well-managed with nodal radiation therapy without nodal resection, but the role of ALND in these patients remains unclear.
2 ALND has clearly been associated with significant morbidity, such as lymphedema, mobility restriction, and chronic pain.
3 Recent trials attempting to de-escalate axillary surgical management have shown feasibility of selective axillary sampling approaches, such as sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD) after neoadjuvant chemotherapy (NAC).
4 Given that cN3b patients receive this staging regardless of degree of axillary involvement, one could extrapolate that some cN3b patients with excellent response to NAC also could benefit from these de-escalated procedures. Our study examined the trends in use of SLNB and ALND for cN3b patients over time and to identify whether the use of SLNB was associated with a difference in outcomes compared with ALND for cN3b patients who achieve nodal pathological complete response (pCR) after NAC. …
