Dr. Chagpar on Management of the Axilla in Breast Cancer

Anees B. Chagpar, MD, FACS, associate professor, Department of Surgery, Yale School of Medicine, assistant director, Global Oncology, Yale Comprehensive Cancer Center, discusses the management of the axilla in breast cancer.

Neoadjuvant chemotherapy is becoming a mainstay in the treatment of patients with locally advanced and operable breast cancer, says Chagpar. This has prompted many physicians to question how to best manage the axilla. Robust clinical trial data have since shown that a sentinel lymph node biopsy is feasible and accurate in the setting of neoadjuvant chemotherapy.

Therefore, for many patients who have had a fine needle aspiration biopsy or a core needle biopsy that indicates lymph node metastases prior to neoadjuvant chemotherapy, patients no longer have to undergo an axillary node dissection, says Chagpar. Rather, a sentinel node biopsy can be done to assess where the patient stands at that point. If they have residual disease, they can then opt for an axillary node dissection. Moreover, there are now trials looking at radiation therapy alone for those patients, concludes Chagpar.