Node Micrometastases Detection After Neoadjuvant Chemotherapy in Breast Cancer: Is It of Clinical Value?

Excerpt

It is thought that detection of micrometastases (mi) or isolated tumor cells (ITCs) in sentinel lymph node biopsy (SLNB) or axillary lymph nodes (ALNs) in breast cancer can have prognostic and predictive clinical utility. The American Joint Committee on Cancer (AJCC) recommends lymph node classification into: pN0 (no metastases > 2 mm), pN1mi (small metastases > 0.2 mm to < 2 mm) and pN0(i +) (ITC deposits < 0.2 mm). However, nobody knows whether detection of mi or ITCs in SNLB should be followed by axillary lymph node dissection (ALND) or if this identification of minimal disease in SLNB or ALNs is a predictive marker for response to adjuvant chemotherapy offering a survival benefit. Even more complicated is the topic of detection of mi or ITCs in ALNs after neoadjuvant chemotherapy (NAC). However, even if mi or ITCs detection has prognostic value, what is the clinical utility given that NAC has been completed? …