ASO Author Reflections: Avoiding an Axillary Lymph Node Dissection: The Benefit of Neoadjuvant Chemotherapy for Occult Primary Breast Cancer

Excerpt

The implementation of neoadjuvant chemotherapy (NAC) has changed the surgical landscape and is increasingly utilized among node-positive patients in attempt to de-escalate axillary surgery. Multiple trials have demonstrated the feasibility of sentinel lymph node biopsy (SLNB) following NAC,1 and patients who convert from cN1 to cN0 following NAC and obtain a nodal pathologic complete response (pCR) may be eligible for SLNB alone. It is now well established that nodal pCR rates vary by receptor profile, and therefore the likelihood of minimizing extent of axillary surgery remains heavily influenced by tumor biology.2,3 Because the literature supporting axillary surgical de-escalation was based on patients with intact primary tumors, it is unknown whether similar rates of pCR would be seen among women with occult primary breast cancer (OPBC), a population historically felt to harbor a heavier nodal disease burden. We sought to determine the frequency of nodal pCR following NAC, and thus the potential omission of ALND, in a cohort of patients with OPBC. …