ASO Author Reflections: Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy for Node-Positive Breast Cancer: Is It Oncologically Safe?

Excerpt

Chemotherapy prior to surgery for the management of breast cancer is advancing, becoming more individualized by tumor subtype and being utilized with improved efficacy, calling for an evolution in surgical care. In patients with clinically node-positive disease at time of diagnosis, large prospective trials have shown that sentinel lymph node surgery after neoadjuvant chemotherapy is feasible with acceptable false-negative rates.1^–3 There are very limited data, however, in patients who present with biopsy-proven node-positive disease with negative sentinel lymph nodes after neoadjuvant chemotherapy regarding the oncologic safety of omitting complete axillary lymph node dissection.4,5 One of these studies was an early report on patient outcomes from our institution, and we have provided further information regarding the clinical adoption of sentinel node surgery in our practice, looking at which patients were being offered sentinel node surgery, how that evolved over time, the pathologic nodal burden for those who had an axillary lymph node dissection, and what percentage of patients were able to be spared axillary dissection, as well as oncologic outcomes with updated follow-up. …