ASO Author Reflections: A Negative Axillary Clinical Exam Adequately Identifies Clinically Node-Positive Patients who Downstage After NAC and are Candidates for SLNB

Excerpt

Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in clinically node-positive patients is a newer approach to axillary management endorsed by the National Comprehensive Cancer Network (NCCN).1 Among patients with a negative axillary clinical examination after NAC, there is no consensus on the most accurate, cost-effective approach to select those who are eligible for SLNB. Magnetic resonance imaging (MRI) and ultrasound (US) are the imaging modalities most frequently used after NAC. US assessment of the axilla shows an accuracy of 62–65% in determining the pathologic status of axillary nodes after NAC,2,3 with 28% of patients potentially undergoing an unnecessary procedure if suspicious US findings are used to assign them to axillary dissection.4 The accuracy of MRI in predicting the status of the sentinel lymph nodes in clinically node-positive patients with a negative axillary clinical exam after NAC has not been studied. …