Axillary Node Management in Patients Receiving Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy (NAC) has increasingly been used to allow breast conservation, without compromising survival or local control. NAC can also downstage nodal status in about 40 % of women with positive nodes (cN+). Concurrently, primary surgical management of the axilla has transitioned towards sentinel lymph node biopsy (SLNB) as the preferred alternative to axillary lymph node dissection (ALND) for clinically node-negative patients. Although some still support SLNB prior to NAC for node-negative breast cancer, the use of SLNB after NAC has become an increasingly accepted practice. SLNB after NAC for node-positive breast cancer has remained more controversial. Recent trials show that the false-negative rates for SLNB after NAC for women presenting with positive nodes are approximately 10 % when two tracers are used for mapping and two or more SLNs are examined. This review summarizes the available evidence and rationale regarding management of regional nodes in women receiving NAC.