ASO Author Reflection: Axillary Dissection for Negative Lymph Nodes in Inflammatory Breast Cancer—Need for Clinical Trials to Reassess Standard of Care

Excerpt

Axillary dissection, part of modified radical mastectomy, remains standard in inflammatory breast cancer (IBC) treatment.1 Yet, there has been a recent deescalation of axillary intervention in non-IBC patients presenting with positive nodes with subsequent complete nodal response to neoadjuvant chemotherapy. Axillary dissection has been replaced by sentinel lymph node biopsy (SLNBx) and removal of the biopsied clipped node (targeted axillary dissection), which is associated with lower morbidity, specifically lymphedema.2,3 Thus, in the era of increasingly effective chemotherapeutic and HER-2-targeted regimens, we asked how frequently IBC patients have pathologically negative lymph nodes (ypN0). Identifying these patients is important as they could potentially benefit from deescalation of axillary intervention. However, a previous feasibility study of SLNBx in IBC failed to identify sentinel nodes in 75% of participants, presenting a challenge to the widespread use of this method in IBC.4 Therefore, we sought to determine how to preoperatively identify patients most likely to have ypN0 to optimize selection for future studies of axillary deescalation techniques. …