Are we Over treating the Axilla in those Undergoing Neoadjuvant Chemotherapy?
Association of Breast Surgery ePoster Library. Jiwa N. 05/15/17; 166289; P009
Ms. Natasha Jiwa
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Abstract
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Introduction
Axillary lymph node status is an important prognostic factor in breast cancer. Patients with an involved axilla at diagnosis having neoadjuvant chemotherapy (NACT) may have down-staging of both the tumour and the axilla.
Evidence for targeted axillary dissection (TAD) is building. TAD localises involved nodes pre-NACT that are targeted during post-treatment surgery. Such patients may be spared the morbidity of axillary lymph node clearance (ALNC). We review the pathology from patients having ALNC following NACT to assess the feasibility of TAD.
Methods
Patients were identified between January 2010 and November 2016. A positive axilla was defined by aspiration cytology (FNAC), core biopsy (NCB) or up-front sentinel node biopsy (SLNB).
Results
40 women had NACT followed by ALNC. Axillary disease was identified following FNAC/NCB in 63% (25/40) and 37% (15/40) had up-front SLNB. No disease was identified in 58% of ALNC specimens following NACT. 87% of patients having upfront SLNB had no further axillary disease. Mean tumour size was 47mm, reducing to 27mm following treatment. 15% achieved complete pathological response and all had clear nodes on ALNC.
Discussion
Patients with good response of their tumour to NACT are more likely to achieve down-staging of the axilla and have the possibility of being spared ALNC. Most patients having up-front SLNB have no additional disease on ALNC suggesting that low-volume nodal disease may be best treated with TAD.
Our data suggests we should stratify axillary surgery based on response to treatment, individualise patient care and spare selected women the morbidity of ALNC.
Axillary lymph node status is an important prognostic factor in breast cancer. Patients with an involved axilla at diagnosis having neoadjuvant chemotherapy (NACT) may have down-staging of both the tumour and the axilla.
Evidence for targeted axillary dissection (TAD) is building. TAD localises involved nodes pre-NACT that are targeted during post-treatment surgery. Such patients may be spared the morbidity of axillary lymph node clearance (ALNC). We review the pathology from patients having ALNC following NACT to assess the feasibility of TAD.
Methods
Patients were identified between January 2010 and November 2016. A positive axilla was defined by aspiration cytology (FNAC), core biopsy (NCB) or up-front sentinel node biopsy (SLNB).
Results
40 women had NACT followed by ALNC. Axillary disease was identified following FNAC/NCB in 63% (25/40) and 37% (15/40) had up-front SLNB. No disease was identified in 58% of ALNC specimens following NACT. 87% of patients having upfront SLNB had no further axillary disease. Mean tumour size was 47mm, reducing to 27mm following treatment. 15% achieved complete pathological response and all had clear nodes on ALNC.
Discussion
Patients with good response of their tumour to NACT are more likely to achieve down-staging of the axilla and have the possibility of being spared ALNC. Most patients having up-front SLNB have no additional disease on ALNC suggesting that low-volume nodal disease may be best treated with TAD.
Our data suggests we should stratify axillary surgery based on response to treatment, individualise patient care and spare selected women the morbidity of ALNC.
Introduction
Axillary lymph node status is an important prognostic factor in breast cancer. Patients with an involved axilla at diagnosis having neoadjuvant chemotherapy (NACT) may have down-staging of both the tumour and the axilla.
Evidence for targeted axillary dissection (TAD) is building. TAD localises involved nodes pre-NACT that are targeted during post-treatment surgery. Such patients may be spared the morbidity of axillary lymph node clearance (ALNC). We review the pathology from patients having ALNC following NACT to assess the feasibility of TAD.
Methods
Patients were identified between January 2010 and November 2016. A positive axilla was defined by aspiration cytology (FNAC), core biopsy (NCB) or up-front sentinel node biopsy (SLNB).
Results
40 women had NACT followed by ALNC. Axillary disease was identified following FNAC/NCB in 63% (25/40) and 37% (15/40) had up-front SLNB. No disease was identified in 58% of ALNC specimens following NACT. 87% of patients having upfront SLNB had no further axillary disease. Mean tumour size was 47mm, reducing to 27mm following treatment. 15% achieved complete pathological response and all had clear nodes on ALNC.
Discussion
Patients with good response of their tumour to NACT are more likely to achieve down-staging of the axilla and have the possibility of being spared ALNC. Most patients having up-front SLNB have no additional disease on ALNC suggesting that low-volume nodal disease may be best treated with TAD.
Our data suggests we should stratify axillary surgery based on response to treatment, individualise patient care and spare selected women the morbidity of ALNC.
Axillary lymph node status is an important prognostic factor in breast cancer. Patients with an involved axilla at diagnosis having neoadjuvant chemotherapy (NACT) may have down-staging of both the tumour and the axilla.
Evidence for targeted axillary dissection (TAD) is building. TAD localises involved nodes pre-NACT that are targeted during post-treatment surgery. Such patients may be spared the morbidity of axillary lymph node clearance (ALNC). We review the pathology from patients having ALNC following NACT to assess the feasibility of TAD.
Methods
Patients were identified between January 2010 and November 2016. A positive axilla was defined by aspiration cytology (FNAC), core biopsy (NCB) or up-front sentinel node biopsy (SLNB).
Results
40 women had NACT followed by ALNC. Axillary disease was identified following FNAC/NCB in 63% (25/40) and 37% (15/40) had up-front SLNB. No disease was identified in 58% of ALNC specimens following NACT. 87% of patients having upfront SLNB had no further axillary disease. Mean tumour size was 47mm, reducing to 27mm following treatment. 15% achieved complete pathological response and all had clear nodes on ALNC.
Discussion
Patients with good response of their tumour to NACT are more likely to achieve down-staging of the axilla and have the possibility of being spared ALNC. Most patients having up-front SLNB have no additional disease on ALNC suggesting that low-volume nodal disease may be best treated with TAD.
Our data suggests we should stratify axillary surgery based on response to treatment, individualise patient care and spare selected women the morbidity of ALNC.
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