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Metastatic Breast Cancer
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Youssri Gaweesh
Jan 10, 2017
No, if sentinel LN is still positive one should proceed for axillary clearance
James Daniel
Jan 13, 2017
I agree. in addition to local therapy to the breast, I would do a sentinel node biopsy and if positive, a true axillary dissection
SOLOMON MUTUA
Jan 13, 2017
What was the clinical nodal status post chemotherapy? Was it cN0 or cN+. If cN+, then the answer is easier - she would require ALND. If she was converted to cN0 post chemotherapy, then it becomes a bit tricky. Sentinel LN biopsy has been shown to have low detection rates (<90%) and high false negative rates (> 10%), according to the SENTINA and ACOSOG Z1071 Trials. It is therefore not a reliable method in the neoadjuvant setting. On the other hand, sentinel node biopsy with mandatory IHC staining (rather than H&E) has been shown to give low false negative rates of 8.4%, but low detection rates of 87.6% (SN FNAC study). IHC of the sentinel LN in this setting requires further evaluation before making its way to the guidelines. Based on these pieces of evidence, I opine that this patient will require an axillary LN dissection to appropriately stage/treat her axillar and that sentinel biopsy is not reliable in the neoadjuvant setting. Appropriate counseling will help the patient understand the risks of not undergoing axillary dissection
CARLOS MONTENEGRO
Jan 16, 2017
IF WE HAVE A COMPLETE RESPONSE DEMONSTRATED BY USOUND AND CT PREOP, WE CAN GO TO RXT IF QUADRANTECTOMY IS PERFOMED WITHOUT AXILLARY CLEARANCE
Anjali Thawani
Feb 08, 2017
@ Solomon Mutua, If you look at Z1071- the false negative rate dropped significantly with attaining 3 or more sentinel nodes, and obtaining the previously biopsied, clipped node. Therefore, after the subset analysis of 1071, SNLB has widely been accepted after NAC. This was further corroborated by Kelly Hunt's paper on Targetted Axillary detection last year.
Mark Moskowitz
Feb 08, 2017
Interesting that an ER+ tumour responded so very well to chemotherapy. I would tell the patient she may be taking a tiny chance of an axillary recurrence w/o axillary dissection and if she's ok with that I'd proceed with XRT and endocrine therapy.
Mohammed Abdullah
Feb 08, 2017
Because of cN1 the patient should get a radical therapy of the axilla independent of response to chemothetapy. I would recommend radiotherapy as it is as effective but less toxic than axillary clearance.
Suresh Kunapareddy
Feb 08, 2017
No ALND. Radiation and hormonal treatment
Juan Rodriguez Agostini
Feb 09, 2017
Excision + SLNB, but if is still positive after chemotherapy, the indication is a complete axillary dissection. But if the patient refuse it, the axillary radiotherapy is an adequate option followed by hormonal therapy
Luis Betancourt
Feb 09, 2017
SLNB .if positive axillary dissection,in case of negative sentinel node(more 2-3 sn) no axillary dissection.
surapong supaporn
Feb 12, 2017
SLNB with combined method..if positive strongly recommend ALND but if negative ALND could be avoided .
banu ozturk
Feb 19, 2017
Axillary LND should be performed.
Apr 24, 2024
Pending Moderator approval.
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Sameer
Nasir
MD
Youssri Gaweesh
Jan 10, 2017
James Daniel
Jan 13, 2017
SOLOMON MUTUA
Jan 13, 2017
CARLOS MONTENEGRO
Jan 16, 2017
Anjali Thawani
Feb 08, 2017
Mark Moskowitz
Feb 08, 2017
Mohammed Abdullah
Feb 08, 2017
Suresh Kunapareddy
Feb 08, 2017
Juan Rodriguez Agostini
Feb 09, 2017
Luis Betancourt
Feb 09, 2017
surapong supaporn
Feb 12, 2017
banu ozturk
Feb 19, 2017
Apr 24, 2024
Pending Moderator approval.