14 doctors weighed in:

If a breast cancer patient undergoes neo-adjuvant chemotherapy, how will she ever know her true nodal status?

14 doctors weighed in
Dr. Barry Rosen
Surgery
12 doctors agree

In brief: 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.

In brief: 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.
Dr. Barry Rosen
Dr. Barry Rosen
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2 comments
Dr. Barry Rosen
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.
Dr. Barry Rosen
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 +.
Dr. Devon Webster
Internal Medicine - Oncology
3 doctors agree

In brief: 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.

In brief: 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.
Dr. Devon Webster
Dr. Devon Webster
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Dr. Sean Canale
Breast Surgery
1 doctor agrees

In brief: "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.

In brief: "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.
Dr. Sean Canale
Dr. Sean Canale
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