Management of the axilla in patients undergoing neoadjuvant chemotherapy for breast cancer

US: ultrasound; FNA: fine needle aspiration; CNB: core needle biopsy; NACT: neoadjuvant chemotherapy; ALND: axillary lymph node dissection; SLNB: sentinel lymph node biopsy; SLN(s): sentinel lymph node(s); RT: radiation therapy.

* cN1 is one or more abnormal lymph nodes in the ipsilateral axilla that are not fixed or matted.

¶ Dual tracers should be used for sentinel node identification. Typically, we remove more than one node, and ideally, three or more.

Δ All patients with a positive FNA or CNB of an axillary node at presentation, or one or more positive nodes after NACT, should receive regional lymph node radiation in addition to breast (if lumpectomy) or chest wall (if mastectomy) RT, unless enrolled in a clinical trial of alternative management.

◊ In this setting, some UpToDate experts perform an axillary US in order to reduce false-negative rates associated with SLNB alone. Other UpToDate experts proceed directly to SLNB, as the use of clips and other methods to mark positive nodes reduces the utility of axillary US in this setting.