In a presentation at the 21st Annual Lynn Sage Breast Cancer symposium Andrea V. Barrio, MD, FACS, spoke on axillary management after neoadjuvant chemotherapy and addressing some of the challenges that come with it, including the lack of nodal recurrence data in patients.
Barrio, attending surgeon at Memorial Sloan Kettering Cancer Center in New York City, sat down with OncLive®, a sister publication to Oncology Nursing News®, to discuss overcoming challenges concerning axillary management and what makes the axillary lymph node dissection so important.
TRANSCRIPTIONWhat we lack in these patients is nodal recurrence data. So, we know that although these patients achieve nodal PCR and the false negative rates are low, we are still awaiting results from larger data sets looking at rates of nodal recurrence in patients and clinically node-positive patients who are treated without XR dissection. I think, unfortunately, what we're seeing is that there is a lot of extrapolation of other data in the upfront surgery setting and many surgeons and institutions are avoiding X-ray dissection in patients who still have disease in the sentinel node after neoadjuvant chemotherapy.
And I showed data demonstrating high rates of residual non-sentinel node disease, over 60% of patients who have a positive sentinel node after chemotherapy will have additional lymph nodes that also have cancer, and by leaving those behind, we don't know the implications of long-term outcomes. I stress the importance if you have any positive sentinel nodes, after neoadjuvant chemotherapy, it's very important to do the completion axillary lymph node dissection, because of a high likelihood of finding residual disease and a lack of data demonstrating safety of omission of axillary lymph node dissection in these patients.