Abstract
Aims
NICE guidelines have not defined the timing of Sentinel Lymph Node Biopsy (SLNB) with respect to neoadjuvant chemotherapy (NACT). While there is an ongoing debate, the emerging consensus is in favour of SLNB following NACT in clinically node-negative (cN0) patients which confers the advantage of better prognostic outcomes as a negative SLNB negates further Axillary Lymph Node Dissection (ALND) and prevents patients having further unnecessary surgery.
Thus, the aim of the study was to establish whether unnecessary ALND can be safely avoided by performing SLNB after NACT.
Method
Retrospective case records review of all patients treated with ALND at a single institution was undertaken from January 2018 to December 2019.
Results
73 patients had ALND in this time frame.
Patients received SLNB before NACT and ALND was performed if they were found node-positive on SLNB.
Out of 73 patients, 24 patients had no further nodal disease, 26 had 1-2 macrometastasis and 23 had 3 or more macrometastasis on ALND.
57/73 patients had early breast cancer (T1/T2). 21/57 were cN0 but and 5/21 had NACT following SLNB and ALND after NACT.
Of the 5 patients, 2 (40%) had no nodal disease on ALND.
Conclusion
40% patients could have avoided ALND if SLNB was done after NACT. Also, 68% (50/73) patients who had ALND only had <2 lymph node macrometastasis. This data implies that patients with early breast cancer may be getting subjected to a second operation which not only is unnecessary but also may have debilitating complications.
Surgeon Attitudes Toward the Omission of Axillary Dissection in Early Breast Cancer
