Sentinel Node Lymph Node Surgery After Neoadjuvant Therapy: Principles and Techniques
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Surgical management of the axilla in breast cancer has been a topic of great interest. While sentinel lymph node biopsy (SLNB) is an established approach for patients undergoing surgical treatment as the first element of their care, there is continued debate regarding surgical management of the axilla in patients receiving neoadjuvant chemotherapy (NAC). In clinically node-negative patients, it has been debated whether or not SLNB should be performed before chemotherapy to accurately determine the clinical stage, or after chemotherapy, thus prioritizing the response to therapy and potentially minimizing axillary surgery. Node-positive patients have undergone axillary lymph node dissection in the past, however this paradigm has been challenged in recent years. Thus, surgeons must understand the importance of accurate axillary information both before and after NAC, and its role in multidisciplinary planning. We present a summary of the data surrounding axillary management in patients receiving NAC, and recommendations for surgical technique.
Jennifer M. Racz has no conflicts of interest or disclosures to declare. Abigail S. Caudle is supported by a National Institutes of Health Cancer Center Support grant (CA16672) and has received travel expenses for speaking engagements from EndoMag. She is also the Principal Investigator for research supported by EndoMag.
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