Judy C. Boughey, MD
Concerns over false-negative rates with sentinel lymph node biopsies have prevented the widespread adoption of sentinel lymph node surgeries in women with node-positive breast cancer. However, improvements in surgical techniques and the development of neoadjuvant therapies have allowed wider eligibility for the procedure, explained Judy C. Boughey, MD.
State of the Science Summit™ on Breast Cancer, Boughey, chair of the Division of Surgery Research, Mayo Clinic, discussed the surgical management of the axilla in patients with node-positive breast cancer and less invasive approaches for disease management.
OncLive: What are the new techniques in the surgical management of women with node-positive breast cancer?
: Women who have node-positive breast cancer are often treated with neoadjuvant chemotherapy. When patients have involvement in the lymph nodes at their initial presentation, the standard, up until several years ago, was to resect all lymph nodes with an axillary lymph node dissection.
A third technique that is being widely adopted is the use of immunohistochemistry. We’re encouraging our pathologists to look a little bit closer at the sentinel lymph node to identify what might be just small volumes of disease, isolated tumor cells, or foci of disease that are less than 1 mm or even less than 0.2 mm in size. Then, [pathologists should] consider those patients as node-positive and proceed with an axillary lymph node dissection.
What are the recommended neoadjuvant therapies for women with node-positive breast cancer?
The neoadjuvant therapies for patients with node-positive breast cancer are continually evolving. In the past, the conversion rate in women who [went from] node-positive to node-negative when treated with neoadjuvant chemotherapy was 20% or 30%. Now, we're seeing conversion rates ranging from 50% to 60%, or even higher. Specifically, patients with HER2-positive breast cancer who receive chemotherapy with dual HER2-targeted therapy are showing conversion rates as high as 65% to 70%.
What is the benefit of surgical management of the axilla for patients?
If a patient had gone to the operating room when they were first diagnosed, the standard recommendation would have been an axillary lymph node dissection. Delivering the chemotherapy in the neoadjuvant setting gives that patient the benefit of seeing [an antitumor response] and a chance to consider less invasive surgery after completing chemotherapy.
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