Evidence-Based Strategies to Minimize the Likelihood of Axillary Lymph Node Dissection in Clinically Node-Positive Patients Following Neoadjuvant Chemotherapy

Ashley A Woodfin; Abigail S Caudle

doi:10.1016/j.soc.2023.05.003

Evidence-Based Strategies to Minimize the Likelihood of Axillary Lymph Node Dissection in Clinically Node-Positive Patients Following Neoadjuvant Chemotherapy

Surg Oncol Clin N Am. 2023 Oct;32(4):693-703. doi: 10.1016/j.soc.2023.05.003. Epub 2023 Jun 9.

Authors

Ashley A Woodfin¹, Abigail S Caudle²

Affiliations

¹ MD Anderson Cancer Center, Breast Surgical Oncology, 1515 Holcombe Boulevard, Houston TX 77030, USA.
² MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston TX 77030-4009, USA. Electronic address: ascaudle@mdanderson.org.

PMID: 37714637
DOI: 10.1016/j.soc.2023.05.003

Abstract

De-escalation of axillary management after neoadjuvant chemotherapy in clinically node-positive patients is feasible. The current literature shows this may be accomplished by sentinel lymph node biopsy (SLNB) with the use of dual tracer and removal of at least 2 sentinel lymph nodes, or by targeted axillary dissection (TAD). The accuracy of TAD has been consistently shown as better than that of SLNB. However, these techniques should only be offered to select patients without extensive axillary disease, understanding that long-term outcomes of minimal axillary surgery in this population are limited at this time.

Keywords: Axillary management; Breast cancer; Neoadjuvant chemotherapy; Node positive; Sentinel lymph node biopsy; Target axillary dissection.

Publication types

Review
Research Support, N.I.H., Extramural

MeSH terms

Axilla
Humans
Lymph Node Excision
Neoadjuvant Therapy*
Sentinel Lymph Node Biopsy
Sentinel Lymph Node*

Grants and funding

P30 CA016672/CA/NCI NIH HHS/United States