Neoadjuvant chemotherapy

Neoadjuvant chemotherapy has been considered a relative contraindication to sentinel lymph node mapping as there are some concerns that this may adversely affect SLN localisation and false-negative rates. However, an increasing body of data suggests that SLNB accurately predicts the status of the axillary nodes in patients who have received preoperative chemotherapy. Overall, the studies of preoperative chemotherapy suggest that the failed localisation rates (85-96%) and the false-negative rates (0-33%) may be slightly higher in this setting (54-59). However, the SLNB is clearly not the major factor determining the use of adjuvant therapy in these patients, so the slightly increased false-negative rate is unlikely to cause harm. Neoadjuvant therapy may eradicate foci of disease in axillary lymph nodes, the long-term clinical significance of negative findings on SLNB after preoperative treatment is less clear. This potential loss of prognostic information may complicate clinical decision making for local treatment, such as, whether completion ALND is indicated, whether radiation is indicated after mastectomy, or which regions should be irradiated after lumpectomy. Therefore, SLNB should be considered before primary systemic therapy, with ALND performed after chemotherapy if disease is present in the SLN (60).

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