ASO Author Reflections: Sentinel Lymph Node Removal After Neoadjuvant Chemotherapy in Clinically Node-Negative Patients Can Stop After Removal of Three Lymph Nodes

Excerpt

The surgical management of breast cancer has been rapidly transforming, with studies showing that patients may be managed adequately with less aggressive interventions. While traditionally all patients underwent axillary lymph node dissection for axillary staging, in patients with low clinical suspicion of nodal disease, sentinel lymph node (SLN) surgery has now been accepted as an accurate way to stage the axilla, including in patients treated with neoadjuvant chemotherapy.1,2 In a similar manner, the appropriate number of SLNs needed to accurately stage the axilla should be removed, without removal of too many nodes to limit morbidity. Previous studies have shown, for patients undergoing primary surgery, once four SLNs have been removed, in cases when they are all negative, removal of additional nodes is unlikely to identify positive nodes; however, this maximum number of SLNs for accurate staging was unknown for clinically node-negative patients following neoadjuvant chemotherapy.3 …