Breast cancer: new guidelines for axillary surgery after neoadjuvant chemotherapy

  • Gandhi A & al.
  • Clin Oncol (R Coll Radiol)
  • 19 Jun 2019

  • Oncology guidelines update
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Takeaway

  • New guidelines for sentinel node biopsy (SNB) or axillary lymph node dissection (ALND) depend on whether patients are clinically node negative (cN0) or node positive (cN1) after neoadjuvant chemotherapy (NACT) and what SNB reveals in cN1 patients.
  • Guidelines come from 5 UK organizations: Association of Breast Surgery; Faculty of Clinical Oncology of the Royal College of Radiologists; UK Breast Cancer Group; National Coordinating Committee for Breast Pathology; and the British Society of Breast Radiology.

Why this matters

  • The performance of SNB in patients who have received NACT has been controversial.

Study design

  • Literature review with recommendations.
  • Funding: None disclosed.

Key recommendations

  • In cN0 patients:
    • SNB may be carried out after completion (or before) of NACT.
  • In cN1 patients:
    • 4 nodes from SNB should be removed with dual mapping.
    • If SNB reveals evidence of complete pathologic response, offer axillary radiotherapy.
    • If SNB reveals isolated tumor cells, micrometastases or macrometastases, offer ALND.
    • If SNB reveals extensive axillary node metastases (clinically/radiologically), proceed to ALND on NACT completion.

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