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Breast Cancer — SCE Medical Oncology MCQ

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ModerateBreast CancerBreast CancerSCE Medical Oncology

A 55-year-old woman with locally advanced breast cancer (cT3 N2) receives neoadjuvant chemotherapy and achieves a clinical partial response. At surgery, what axillary staging procedure is appropriate following neoadjuvant chemotherapy with initially node-positive disease?

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Correct answer: C — Axillary lymph node dissection

For patients who present with biopsy-proven axillary node-positive disease, ALND remains the standard after neoadjuvant chemotherapy, even if imaging suggests nodal response. The SENTINA and ACOSOG Z1071 trials showed unacceptably high false-negative rates for SLNB post-NACT in initially node-positive patients when fewer than 3 sentinel nodes are retrieved. Targeted axillary dissection (TAD: clipped node retrieval + SLNB) is an emerging alternative with improved accuracy.

Reference: NICE NG101; ESMO 2024 Early Breast Cancer Guidelines; ACOSOG Z1071; SENTINA