Axillary nodal management following neoadjuvant chemotherapy : A review
Cet article passe en revue les études concernant d'une part l'efficacité d'une chimiothérapie néoadjuvante pour réduire le recours à un curage ganglionnaire axillaire chez les patientes atteintes d'un cancer du sein opérable et, d'autre part, la performance de la technique du ganglion sentinelle après une chimiothérapie néo-adjuvante pour établir avec précision le statut ganglionnaire des patientes
Importance : The increasing use of neoadjuvant chemotherapy (NAC) for operable breast cancer has raised questions about optimal local therapy for the axilla.
Observations : Sentinel lymph node biopsy (SLNB) after NAC in patients presenting with clinically negative nodes has an accuracy similar to upfront SLNB and reduces the need for axillary lymph node dissection compared with SLNB prior to NAC. In patients presenting with node-positive disease, clinical trials demonstrate that SLNB after NAC is accurate when 3 or more sentinel nodes are obtained, but long-term outcomes are lacking. The relative importance of pre- and post-NAC stage in predicting risk of locoregional recurrence remains an area of controversy.
Conclusions and Relevance : Neoadjuvant chemotherapy reduces the need for axillary lymph node dissection, and SLNB is an accurate method of determining nodal status after NAC.
JAMA Oncology , résumé, 2015