Targeted Axillary Dissection for Patients Who Convert to Clinically Node Negative After Neoadjuvant Chemotherapy for Node-Positive Breast Cancer

Abstract

The use of neoadjuvant chemotherapy (NAC) for breast cancer (BC) can eradicate axillary disease in > 40% of patients. The standard of care for node-positive BC has been axillary lymph node dissection. In this review, we examine the data for de-escalating axillary surgery after NAC. Studies have shown that sentinel lymph node biopsy (SLNB) is accurate after NAC. False negative rates (FNR) of SLNB after NAC in node-positive patients have been reduced with a combination of dual tracers and localization of the clipped positive node. Clipped nodes may be localized with a variety of methods. Targeted axillary dissection (removal of clipped node in conjunction with SLNB) results in an acceptable FNR and can be considered in certain patients with axillary clinical response to neoadjuvant chemotherapy. Patient selection is important, as those with persistently positive nodes on clinical exam should proceed directly to axillary dissection.