Dr. Boughey on Surgical Management of Patients With Node-Positive Breast Cancer

Judy C. Boughey, MD, chair, Division of Surgery Research, Mayo Clinic, discusses the surgical management of patients with node-positive breast cancer.

Traditionally, patients with node-positive breast cancer received a full axillary dissection. However, work is investigating whether patients who receive neoadjuvant chemotherapy can avoid the morbidity of the procedure and receive a sentinel lymph node surgery instead. Trials to date have shown false negative rates with the procedure, but there have been several advances in approaches that are driving down the false negative rate and improving the safety of the procedure, Boughey explains.

Examples of these approaches include ensuring that the surgeon uses a dual tracer to increase the identification rate of the sentinel node and decrease the false negative rate associated with sentinel lymph node surgery. Another technique is using a clip to identify the lymph node during surgery. A third technique that is widely adopted is the use of immunohistochemistry to better select patients who stand to benefit from an axillary lymph node dissection.