Sentinel Node Biopsy Alone or With Axillary Dissection After Primary Chemotherapy
Sentinel Node Biopsy Alone or With Axillary Dissection After Primary Chemotherapy
Many doctors believe that breast cancer patients scheduled for pre-operative chemotherapy
 whose cancer has spread to the axilla (determined by palpation plus ultrasound) should not
 receive sentinel node biopsy after chemotherapy, but proceed directly to removal of all the
 axillary lymph nodes.

 In this study, breast cancer patients with operable medium-size cancer (T2) scheduled for
 pre-operative chemotherapy, and a disease-free or a metastatic axilla, are prospectively
 assigned to receive sentinel node biopsy as part of their post-chemotherapy surgical
 treatment (whose main aim is to remove the cancer in the breast).

 Irrespective of whether the axilla is disease-free or metastatic before chemotherapy, if the
 removed sentinel nodes are disease-free on histological examination (pN0) after chemotherapy,
 then no further axillary treatment is given. If however the sentinel nodes contain cancer,
 then the other axillary lymph nodes will be removed surgically.

 The study hypothesis is that, irrespective of whether the axilla is disease-free or
 metastatic before chemotherapy, patients with negative axillary sentinel nodes on
 histological examination (pN0) after chemotherapy, and who are no given further axillary
 treatment, will do as well as pN1 patients whose axillary lymph nodes are completely removed
 (a more aggressive treatment).
Inclusion Criteria:

 -  cT2 cN0/1 breast cancer

 -  Scheduled for neoadjuvant chemotherapy,

 -  Informed consent,

 Exclusion Criteria:

 -  Previous malignancy at another site

 -  Synchronous breast cancer at diagnosis

 -  Distant metastasis at diagnosis

 -  Clinically involved axilla (cN1) after neoadjuvant chemotherapy