REVIEW  AXILLARY MANAGEMENT IN BREAST CANCER 

Minerva Chirurgica 2020 December;75(6):400-7

DOI: 10.23736/S0026-4733.20.08600-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Axillary management after neoadjuvant treatment

Giacomo MONTAGNA ^{1, 2} ✉, Giovanni CORSO ^{3, 4}, Rosa DI MICCO ^{5, 6}, Nathalie VAN DEN RUL ⁷, Nicola ROCCO ⁸

¹ Breast Unit, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; ² Breast Center, University Hospital of Basel, Basel, Switzerland; ³ Division of Breast Surgery, IRCCS European Institute of Oncology, Milan, Italy; ⁴ Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; ⁵ Breast Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy; ⁶ Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; ⁷ Breast Unit, Jessa Hospital, Hasselt, Belgium; ⁸ Group for Reconstructive and Therapeutic Advancements (GRETA) Milan-Naples-Catania, Milan, Italy

Since its introduction nearly 30 years ago, sentinel lymph node biopsy (SLNB) has become the standard technique to stage the axilla for the great majority of patients with early breast cancer. While the accuracy of SLNB in clinically node-negative patients who undergo neoadjuvant chemotherapy (NAC) is similar to the upfront surgery setting, modifications of the technique to improve the false negative rate are necessary in node-positive patients at presentation. Currently, patients who present with matted nodes, cN1 patients who fail to downstage to cN0 with NAC and those with pathological residual disease have an indication to undergo axillary lymph node dissection. Ongoing trials will confirm if extensive nodal irradiation can replace surgery in patients with residual nodal disease after NAC and if nodal radiotherapy can be omitted in patients who achieve nodal pathological complete response. The aim of this review was to focus on the open questions on the management of the axilla after NAC.

KEY WORDS: Breast neoplasms; Chemotherapy, adjuvant;Axilla; Sentinel lymph node biopsy