A 45-year-old woman with clinically node-negative cT2 N0 ER+ HER2- breast cancer undergoes neoadjuvant chemotherapy. Post-NAC, she achieves a complete pathological response (pCR) in the breast. A dual-tracer (blue dye + radioisotope) sentinel lymph node biopsy (SLNB) is performed. Only 1 sentinel node is identified and is negative. Is axillary lymph node dissection (ALND) warranted?
- A No — if 1–2 sentinel nodes are negative after dual-tracer SLNB and there is pCR, ALND is omitted; SLNB is accepted after neoadjuvant chemotherapy in clinically node-negative patients ✓
- B Yes — ALND is mandatory when fewer than 3 sentinel nodes are identified
- C Yes — pCR in the breast does not exclude nodal metastasis and ALND is always required
- D No — no further axillary surgery is needed regardless of number of sentinel nodes retrieved
Correct answer: A. No — if 1–2 sentinel nodes are negative after dual-tracer SLNB and there is pCR, ALND is omitted; SLNB is accepted after neoadjuvant chemotherapy in clinically node-negative patients
Explanation
In clinically node-negative patients (cN0) undergoing SLNB after neoadjuvant chemotherapy, current guidelines (ASCO, SSO) allow omission of ALND when SLNB with dual tracer yields negative sentinel nodes, even if fewer than the traditional threshold of 3 nodes. The false-negative rate is acceptable with dual-agent technique when combined with clip-marking of positive nodes before NAC. pCR in both breast and axilla further supports this approach.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.