Dr. Chagpar Discusses Sentinel Node Biopsying

Anees Chagpar, MD, MSc, MA, MPH, Associate Professor of Surgery (Oncology), Director, The Breast Center at Smilow Cancer Hospital at Yale-New Haven, gives an overview of the discussion surrounding sentinel node biopsying before and after neoadjuvant chemotherapy.

The sentinel node biopsy, a minimally-invasive technique to accurately stage the axilla, was one of the greatest advances in breast cancer surgery over the last 20 years, Chagpar says. Sentinel node biopsy before neoadjuvant chemotherapy has always been comfortable for physicians, as the false-negative rate is low. Now, patients are receiving neoadjuvant chemotherapy and are getting pathologic complete response, so the question remains whether sentinel node biopsy can be performed after.

Advocates of a sentinel node biopsy before neoadjuvant chemotherapy assert that it is possible to more accurately identify the sentinel node with a lower false-negative rate to more accurately stage the axilla.

Advocates of a sentinel node biopsy after neoadjuvant chemotherapy maintain that the identification rate is still good and that false-negative rates are low enough. If physicians can find a sentinel node after neoadjuvant chemotherapy that is negative, it's possible to spare patients an axillary node dissection.