A 54-year-old male asked:
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if a breast cancer patient undergoes neo-adjuvant chemotherapy, how will she ever know her true nodal status?

3 doctor answers
Dr. Barry Rosen
33 years experience General Surgery
Sentinel LN Biopsy: It is somewhat controversial when to perform sentinel lymph node (ln) biopsy in this setting: some advocate performing this prior to chemo, so as to determine an accurate stage; others believe that the status of the ln after chemo is most pertinent. In my practice, i will perform a needle-biopsy of any abnormal ln prior to chemo. If none are evident, i wait until after chemo.
Answered on Mar 4, 2016
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Dr. Barry Rosen
Dr. Barry Rosen commented
33 years experience General Surgery
Provided original answer
If the sentinel LNs are clear, there is no need for axillary dissection. If they contain cancer, a limited dissection is still indicated to determine the need for radiation therapy, not chemotherapy, since the chemo has been completed already. For early breast cancers, an important study (Z-11 trial) has shown that it may no longer be necessary to remove more LNs even if the sentinel node is +.
Jan 5, 2012
Dr. Barry Rosen
Dr. Barry Rosen commented
33 years experience General Surgery
Provided original answer
The statistical probability of a non sentinel LN having cancer cells present but the sentinel node being clear is very low. Keep in mind that LN removal does not improve survival, it only guides therapy.
Jan 5, 2012
Dr. Devon Webster
21 years experience Medical Oncology
She won't: I used to always ask surgeons to do a sentinel node biopsy before neoadjuvant chemotherapy for that very reason. However, newer data show the lymph node status after chemotherapy may be more important. Newer data also show that women don't always need a full axillary dissection with a few positive nodes, so i'm ok with either approach if the lymph nodes aren't enlarged to start.
Answered on Apr 28, 2012
Dr. Sean Canale
29 years experience Breast Surgery
"true" nodal status?: With neoadj therapy, prognostic infor of staging after therapy is likely the more telling. Studies show slnbx after chemo still accurately predicts axillary nodal status. With current chemo, a 20-25% PCR is not unexpected and would include clearing previously pos nodes (found clinically or on prechemo ax u/s & fna). Delaying the slnbx can thus spare these patients additional axillary surgery.
Answered on May 4, 2016
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