Management of the Axilla After Neoadjuvant Therapy: Current Data and Controversies

Neoadjuvant chemotherapy (NAC) is the standard treatment for patients with locally advanced breast cancer or inoperable breast cancer and is administered with the intention of downstaging the tumor. Until recently, axillary staging for invasive breast cancer was performed by complete axillary lymph node dissection for all patients presenting with a breast cancer diagnosis. However, with the development of lymphatic mapping techniques, sentinel lymph node biopsy (SLNB) has become the accepted standard of care for axillary staging of breast cancers. It diminishes the potential morbidity of an axillary dissection, including paresthesias and lymphedema, but involves the risks of an operative procedure. Despite its use, there is tremendous debate about the use of SLNB in patients receiving neoadjuvant chemotherapy. Management of the axilla in the face of neoadjuvant chemotherapy is addressed in this article.