Axillary staging prior to or after neoadjuvant systemic therapy? A single institutional experience.

BACKGROUND

The study aim was to investigate our institutional strategies for axillary staging in breast cancer patients undergoing neoadjuvant therapy.

METHODS

We identified 595 patients treated with neoadjuvant therapy between 2000 and 2007. Axillary staging occurred by four methods: (1) pre-therapy fine needle aspiration biopsy (FNAB); (2) pre-therapy sentinel lymph node biopsy (SLNB); (3) post-therapy SLNB; or (4) post-therapy axillary lymph node dissection (ALND).

RESULTS

Of 595 patients, 115 underwent FNAB (Group 1; 36 N0, 79 N+), 88 underwent SLNB pre-therapy (Group 2; 47 N0, 41 N+), 55 underwent SLNB post-therapy (Group 3; 42 N0, 13 N+), and 337 underwent ALND post-therapy (Group 4; 133 N0, 204 N+). There was no difference between groups according to patient age, race, stage of disease, estrogen/progesterone receptor and Her-2neu status, or type of neoadjuvant therapy.

CONCLUSIONS

The lack of standardized recommendations for axillary staging in the setting of neoadjuvant therapy leads to variable approaches within an institution. The use of ALND without pre-therapy axillary assessment may result in over-treatment of patients. Randomized clinical trials are needed to determine the feasibility and accuracy of SLNB following neoadjuvant therapy. Until such data are available, pre-therapy axillary staging may reduce the number of unnecessary lymph node dissections.