Sentinel lymph node biopsy after neoadjuvant systemic therapy

As sentinel node biopsy has emerged as a possible alternative to axillary node dissection in patients with operable breast cancer, this procedure is also emerging as a possible alternative in patients who have received prior neoadjuvant chemotherapy. Initial smaller, single-institution series with the latter approach have shown significant variability in the identification rates and false negative rates resulting in inconsistent--and at times disparate--conclusions regarding the appropriateness of this technique in this group of patients. Subsequent larger, multicenter series have shown, that the identification rates and false negative rates with sentinel node biopsy after neoadjuvant chemotherapy are similar to those when sentinel node biopsy is performed after breast cancer diagnosis. Thus, it appears that the sentinel node concept is also applicable in patients who have undergone neoadjuvant chemotherapy. This observation has the potential to expand the utility of neoadjuvant chemotherapy in patients with operable breast cancer.