Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy

Neoadjuvant chemotherapy (NACT) does not prolong survival compared with adjuvant chemotherapy, but reduces the need for mastectomy and axillary lymph-node dissection, and thus surgical morbidity, without increasing the risk of locoregional recurrencePatients with high-grade oestrogen receptor (ER)-negative and/or HER2-positive breast cancers are more likely to experience pathological complete response to NACT than those with low-grade, ER-positive tumoursLumpectomy, following NACT, does not need to remove the entire volume of breast tissue initially occupied by the tumourSentinel lymph-node biopsy (SLNB) after NACT accurately stages the axilla and is associated with a low rate of nodal recurrence in patients presenting with clinically negative axillary lymph nodesIn patients who convert to clinically node-negative disease, SLNB after NACT has a false-negative rate of <10% only when ≥3 sentinel nodes are identified; nodal recurrence rates after SLNB alone in this population are unknownThe relative contribution of pre-NACT and post-NACT stage (degree of pathological response) to local control is uncertain; tailoring local therapy based on response to NACT is being evaluated in ongoing trials