Metal Clip Identification of Sentinel Node-Positive Breast Cancer after Neo adjuvant Chemotherapy - Abstract
Breast cancer patients with cN1-3 disease undergoing neo-adjuvant chemotherapy (NACT) and who need a mastectomy for multiple primary tumors in overlapping quadrants are currently advised to undergo a complete axillary lymph node dissection (CALND). In these cases sentinel lymph node biopsy (SLNB) is usually not recommended. However, as demonstrated in this case report this paradigm may be shifting. Frozen section of a SLNcontaining a metal clip, placed at the time of pre-treatment needle biopsy under ultrasound guidance, may confer multiple benefits. This includes the clipped node demonstrating complete pathologic response, identifying a cohort of patients who might avoid CALND without adversely affecting overall survival, or reveal patients in whom residual metastatic disease perhaps justifies CALND. There is also a cohort of patients in whom the SLN doesn’t contain the clip and in whom it is not clear whether a complete pathologic response has been achieved.