[Normalization in axillary lymph node management after neoadjuvant therapy for breast cancer]

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Neoadjuvant chemotherapy (NAC) can downstage breast cancer primary lesions and axillary lymph nodes.
• This downstaging presents opportunities for less invasive surgical approaches, including sentinel lymph node biopsy (SLNB).
• Current SLNB detection and false negative rates in post-NAC patients may not meet clinical standards.

Purpose of the Study:

• To evaluate the challenges and opportunities of individualized breast cancer surgical treatment following NAC.
• To define the criteria and necessary conditions for safe and effective SLNB in post-NAC patients.
• To improve the accuracy and reliability of SLNB in assessing axillary lymph node status after NAC.

Main Methods:

• Review of clinical practice standards for SLNB in early breast cancer patients post-NAC.
• Emphasis on the need for advanced imaging, experienced medical teams, and precise lymph node evaluation.
• Specific recommendations for patient selection (cN0 to ycN0 or cN1 to ycN0) and technique (dual tracer, >2 SLNs, targeted dissection).

Main Results:

• Downstaging of primary lesions offers surgical options for previously inoperable patients.
• Downstaging of lymph nodes makes SLNB a potential replacement for axillary lymph node dissection.
• SLNB in post-NAC patients faces challenges with detection and false negative rates, requiring stringent protocols.

Conclusions:

• SLNB in post-NAC patients necessitates specialized medical teams and advanced equipment.
• Strict patient selection criteria and advanced surgical techniques are crucial for safe SLNB.
• Dual tracer methods, increased sentinel lymph node retrieval, and targeted dissection enhance SLNB safety and efficacy in select post-NAC patients.