Sentinel node biopsy after neoadjuvant chemotherapy for node-positive breast cancer: Does axillary ultrasound improve performance?
Copyright © 2015 American Society of Clinical Oncology. All rights reserved.A 66-year-old otherwise healthy woman palpates a lump in the lower inner quadrant of her left breast; she has no family history of breast or ovarian cancer and is not of Ashkenazi heritage. Clinical examination confirms a mobile 2-cm mass at 8:00 in her left breast; the axilla is clinically negative. Mammography is negative, but ultrasound (US) shows a 2.2-cm irregular hypoechoic nodule corresponding to the palpable mass, and US-guided core biopsy shows poorly differentiated invasive ductal carcinoma, triple negative (estrogen receptor, 0; progesterone receptor, 0; and human epidermal growth factor receptor 2, 0). US also notes a single suspicious 1-cm node in the left axilla, which US-guided core biopsy shows to be metastatic carcinoma (Fig 1). Clips placed to mark the sites of the breast and axillary biopsies are in appropriate position. She receives dose-dense neoadjuvant chemotherapy (NAC) with doxorubicin, cyclophosphamide, and paclitaxel, with completeresolution of her physical findings but with persistence of an abnormal left axillary node on US. She then has a left partial mastectomy with I-125 seed localization of the clip marking the core biopsy site and a left sentinel lymph node (SLN) biopsy using combined dye-isotope mapping. Final pathology confirms no cancer in the breast or in four SLNs; treatment effect is present in the breast and in the single SLN containing the clip placed at the time of biopsy.
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