[The possibility of eliminating axillary dissection in breast cancer patients using neoadjuvant treatment]

Neoadjuvant systemic treatment in breast cancer was initially utilized for patients with locally advanced tumors to achieve resectability. Later on it moved to earlier cancer stages, thus allowing more breast conservations. Current explorations seek to find out whether its effect on axillary metastases could eliminate axillary dissection in treatment responders. Three large prospective trials have studied the accuracy of sentinel lymph node biopsy (SLNB) after clinical regression of nodal metastases in the axilla.

As shown by the results, false negativity of SLNB exceeds 10%, which is considered as unacceptably high. The false negativity can be reduced by using the dual tracer technique and/or by removing three nodes at the minimum. An even more promising approach consists in marking the initially metastatic node to ensure its surgical removal along with the regular sentinel nodes. This procedure has been described as "TAD" (Targeted Axillary Dissection), and extirpation of the marked node is now recommended in NCCN guidelines. However, the appropriate surgical procedure to be used to stage the axilla after clinical regression of nodal metastases still remains a matter of debate. Above all, safety of the conservative approach with respect to local regional control and overall survival is yet unknown.

Longer follow-up is needed to assess this issue. Despite that, the use of neoadjuvant systemic treatment to reduce axillary dissections seems promising from the current perspective.Key words: breast cancer - neoadjuvant treatment - sentinel lymph node biopsy - axillary dissection - false negativity.