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[Members Only] J.Jpn. Surg. Soc.. 125(5): 423-429, 2024
Feature topic
OMISSION OF AXILLARY LYMPH NODE DISSECTION FOR PATIENTS WITH CLINICALLY NODE-POSITIVE BREAST CANCER
Neoadjuvant chemotherapy (NAC) has eradicated axillary lymph node metastasis in approximately 40％ of patients with clinically node-positive (cN+) breast cancer. These patients would be candidates for deescalation of axillary surgery as an alternative to axillary lymph node dissection (ALND). However, sentinel lymph node biopsy (SLNB) for cN+ cases has been shown to increase the false-negative rate and decrease the identification rate. To improve the oncological safety of SLNB, it is recommended to perform SLNB with dual tracers and excise at least three sentinel nodes. In recent years, the validity of tailored axial surgery (TAS), in which metastatic lymph nodes are marked with clips before NAC and removed with SLNs, has been reported. The omission of ALND for patients with cN+ breast cancer after NAC can allow for reducing complications such as lymphedema and improvement of patients’ quality of life.
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