How could node-positive breast cancer patients benefit from post-neoadjuvant chemotherapy slnb adopting acosog z1071 end recommendations

Introduction: axillary lymph node status is one of the most significant prognostic factors that guide treatment strategy in breast cancer. Patients with advanced tumor or axillary nodal metastasis could benefit from neoadjuvant chemotherapy (NAC) resulting in down-staging of the disease. Sentinel lymph node biopsy (SLNB) in patients with axillary nodal disease is debated regarding its identification rate (IR) and false negative rate (FNR). American College of Surgeons Oncology Group (ACOSOG) conducted a large trial to assess SLNB in such patients and it showed depressing outcome resulting in proposition of some recommendations and modification in their methodology when SLNB to be carried out. In this study we adopt ACOSOG Z1071 recommendation to assess SLNB in post-NAC node-positive breast cancer patients. Methods: This study included 42 breast cancer patients with pathologically proved nodal metastasis. SLNB carried out in patients who showed clinical negative nodes after NAC. Three or more SLNs was mandatory to continue the assigned management pathway, while less than 3 nodes or failure to identify any SLN shift the patient to axillary lymph node dissection (ALND). Detailed evaluation of SLNs and nodes yielded from ALND was done and data interpreted to show how far such patient could benefit from such procedure and if any could spared ALND. Results: From 42 patients included in the study clinical conversion rate after NAC to negative axilla was 78.6%. 33 patients underwent SLNB with identification rate of 84.8%. Three or more SLNs were identified in 20 patients. 24% of patients subjected to SLNB were spared axillary dissection. On final evaluation of all retrieved nodes in all limbs of the study we assumed that neoadjuvant chemotherapy resulted in pathological complete response in 35% of our studied group. Conclusions: SLNB following NAC in node-positive patients is feasible and can be a future standard of care with some modification in methodology adopting recommendations released from large concerned trials.