ASO Author Reflections: Rate of Axillary Lymph Node Dissection has Decreased in Patients Treated with Neoadjuvant Systemic Therapy

Excerpt

For patients who presented with node-positive breast cancer who were treated with neoadjuvant systemic therapy (NST), axillary lymph node dissection (ALND) has been the standard of care at the time of surgery. The last decade has seen an expanded role of NST with an increase in its use in the treatment of breast cancer, especially in triple negative breast cancer and HER-2 positive disease. During the same time period, more effective chemotherapy regimens became available, and targeted agents were introduced into mainstream practice for HER-2 positive subtypes. As a result, higher rates of pathologic complete response (pCR) in the axilla were seen. Due to the morbidities of ALND and that the removal of negative lymph nodes has not been shown to increase survival, sentinel lymph node (SLN) surgery for axillary staging was gaining significant interest. The feasibility of staging the axilla with SLN surgery after NST in patients with node-positive disease at presentation was evaluated with three multi-institutional studies.1‐3 Results of these studies identified methodologies that optimize the reliability of SLN surgery in this setting. We sought to evaluate and describe the shift in axillary surgery over time in our practice. …