Management of the Axilla in the Setting of Neoadjuvant Therapy for Breast Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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:
    • Downstaging 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 disease and 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%:
      • But 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 recommende
  • References
  • 1. 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.
  • 2. 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.
  • 3. 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.
  • 4. 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 #Mexico #Doctor #MountSinaiMedicalCenter #MSMC

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Leave a Reply

Fill in your details below or click an icon to log in:

Gravatar
WordPress.com Logo

You are commenting using your WordPress.com account. ( Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. ( Log Out /  Change )

Cancel

Connecting to %s