Axillary Dissection, Is It Always Necessary in Patient Receiving Neoadjuvant Chemotherapy due to Breast Cancer?

Objective: With the development of neoadjuvant chemotherapy (NACT) drugs, neoadjuvant chemotherapy is increasingly used in the treatment of breast cancer. Complete or near complete response rates in primary tumour are progressively increasing as well metastatic lymph nodes in the axilla are regressed. While surgeons had previously thought that lymph nodes at all axillary levels should be completely removed, it has been shown that has no effect on survival. Limited lymph node dissection for staging is sufficient. One reason for this tendency is the possible morbidity of axillary dissection (AD), which decreases the comfort of life. Therefore, surgeons are now looking for ways to not perform unnecessary axillary dissection. AD is gradually being replaced by sentinel lymph node biopsy (SLNB). It is known that lymph node negativity can be achieved after chemotherapy. In this study, we investigated the effect of neoadjuvant chemotherapy on axillary metastases. Material and Method: 154 patients who underwent neoadjuvant chemotherapy (NACT) and underwent breast conserving surgery / total mastectomy + AD were included in the study. The data were analyzed retrospectively. Fifteen patients had inflammatory breast cancer. Physical examination records, USG, MRI, PET/CT and axillary lymph node biopsy results before neoadjuvant chemotherapy were evaluated. Results were compared with pathological results of axillary dissection material. Results: Total mastectomy was performed in 117 patients and breast conserving surgery was preferred in 37 patients. In 32 patients who underwent fine needle aspiration biopsy before NACT, malignant lymph node was found in axilla. The pathology of AD was reported as malignant in 53.1% of these patients, and no malignancy was detected in 46.9% of them. 52.7% of 129 patients who has radiological axillary pathological lymph nodes were found to be malignant after NACT but 47.3% was as benign detected. When clinical, imaging and biopsy results were taken together, pathological axillary lymph nodes were detected in 138 patients. After NACT malignancy continued in 54.3% of them and response was obtained in 45.7%. Conclusion: Overall, approximately 46% of patients with NACT respond to chemotherapy in metastatic axillary lymph nodes. More studies can help us to answer the questions what type of breast cancer has a better response, which chemotherapy regimen are more effective. [ABSTRACT FROM AUTHOR]