Management of the Axilla in the Setting of Neoadjuvant Therapy

  • Management of the axilla continues to evolve in the setting of neoadjuvant therapy
  • Sentinel lymph node biopsy (SLNB):
    • In clinically node-negative patients after neoadjuvant chemotherapy is feasible and accurate:
      • A recent systematic review:
        • Reported a pooled identification rate of 96% and false negative rate of 6%:
          • These data do not differ from studies evaluating SLNB in early breast cancer without neoadjuvant chemotherapy
  • Neoadjuvant chemotherapy:
    • Can result in down staging of the axilla
  • Performing the SLNB after chemotherapy:
    • Decreases the rate of finding a positive sentinel lymph node and subsequent axillary dissection:
      • The Alliance Z1071 trial:
        • Involved patients with:
          • Initially node-positive
        • It sought to determine the false negative rate for sentinel lymph node surgery following neoadjuvant chemotherapy in this group of patients
        • The false negative rate:
          • For the entire cohort was 12%
        • On additional analysis:
          • Retrieval of at least two sentinel nodes and the previously biopsied node:
            • Was associated with a false negative rate of 6.8%
          • Therefore, marking the biopsied node with a clip and documenting excision at time of SLNB is recommended
  • References:
  • Geng C, Chen X, Pan X, Li J. The feasibility and accuracy of sentinel lymph node biopsy in initially clinically node-negative breast cancer after neoadjuvant chemotherapy: a systematic review and meta-analysis. PLoS One. 2016;11(9):e0162605.
  • Hunt KK, Yi M, Mittendorf EA et al. Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients. Ann Surg. 2009;250(4):558-566.
  • Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455-1461.
  • Boughey JC, Ballman KV, Le-Petross HT et al. identification and resection of clipped node decreases the false-negative rate of sentinel lymph node surgery in patients presenting with node-positive breast cancer (T0-T4, N1-N2) who receive neoadjuvant chemotherapy: results from ACOSOG Z1071 (Alliance). Ann Surg. 2016;263(4):802-807.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #Miami #CASO #CenterforAdvancedSurgicalOncology

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