Implementation of the american college of surgeons oncology group z1071 trial data in clinical practice: is there a way forward for sentinel lymph node dissection in clinically node-positive breast cancer patients treated with neoadjuvant chemotherapy?

摘要: For clinically node-positive breast cancer patients receiving neoadjuvant chemotherapy, approximately 40 % will be found to pathologically node negative. The American College of Surgeons Oncology Group Z1071 trial was therefore conducted evaluate sentinel lymph dissection (SLND) in these patients. trial’s primary end point determine the false-negative rate (FNR) among with clinical N1 disease whom at least 2 nodes (SLNs) were identified. FNR 12.6 %, which exceeded prespecified 10.0 %. After data publication, our multidisciplinary team discussed results and how we may incorporate findings into practice. Patient selection surgical technique are critical. As an example, when dual tracer used, 10.8 %. Data from presented San Antonio Breast Cancer Symposium suggested that could improved if a clip placed biopsy-proven positive removal during SLND confirmed. Taking this consideration, have proposed approach management axilla chemotherapy termed targeted axillary (TAD). TAD involves placing time is determined positive. completion clipped localized by using wire or radioactive seed, procedure, all SLNs removed. We currently evaluating efficacy staging after chemotherapy.