Ali Hassan,Ihab Samy,Amany Saber,Reda Tabashy,Mona Sakr. Evaluation of the effect of neoadjuvant chemotherapy on tumor and axillary lymph nodes in locally advanced breast cancer: a study of 50 patients. Oncol Transl Med, 2014, 13: 363-369.
Evaluation of the effect of neoadjuvant chemotherapy on tumor and axillary lymph nodes in locally advanced breast cancer: a study of 50 patients
Received:June 20, 2014  Revised:August 12, 2014
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KeyWord:locally advanced breast cancer (LABC); neoadjuvant chemotherapy (NACT); axillary nodes
Author NameAffiliationE-mail
Ali Hassan Department of Surgical Oncology,National Cancer Institute,Cairo University,Cairo ,Egypt 
Ihab Samy Department of Surgical Oncology,National Cancer Institute,Cairo University,Cairo ,Egypt 
Amany Saber Department of Medical Oncology,Minia Cancer Center,El Minia,Egypt  
Reda Tabashy Department of Radio-diagnosis,National Cancer Institute,Cairo University,Cairo ,Egypt  
Mona Sakr National Cancer Institute  
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      Objective: The purpose of the study was to correlate between effect of pre-neoadjuvant chemotherapy (NACT) and post-NACT clinical, sonographic and pathologic features of the tumor and axillary lymph nodes (ALNs) and to raise the possibility of applying the concept of sentinel lymph node biopsy (SLNB) in patients with initially positive ALNs before NACT. Methods: A prospective study of 50 female patients with locally advanced breast cancer (LABC) with clinically palpable and cytologically (under ultrasonographic guidance) positive ALNs. All patients received NACT and then referred for ultrasonographic assessment of the axilla regarding any detectable sonographic criteria of metastatic deposits in ALNs as well as the tumor size in relation to its pre-chemotherapy size. All patients were then subjected either to modified radical mastectomy or breast conserving surgery. The clinical, sonographic and pathological response of the tumor and the ALNs were documented, classified and correlated with each other. Results: Patients’ mean age was 47.7 ± 9.1 years. The mean clinical tumor size was 6.7 ± 1.4 cm; stage IIIA that was presented in 32 patients (64%) and IIIB was presented in 18 patients (36%). Chemotherapy was given for a median of 4 cycles. there was reduction of the mean clinical tumor size from 6.7 ± 1.4 cm to 4.3 ± 2.7 cm (P < 0.001). Clinical response was complete in 5 (10%) tumors, complete pathological tumor response (post-neoadjuvant) was detected in 8 (16%) of patients. Complete clinical nodal response (post-neoadjuvant) in 23 (46%) axillae, on sonographic assessment of the axilla, response was complete in 17 (34%) axillae. Complete pathological nodal response occurred in 16 (32%) axillae. Out of 17 axillae that showed complete sonographic response 11 axillae showed complete pathological nodal response (P < 0.001). Conclusion: Formal axillary lymph node dissection can be avoided and replaced by SLNB post NACT in patients with LABC with metastatic ALNs if there were complete clinical and sonographic criteria of nodal response as well as complete pathological tumor response.