Dr Yuan on Minimizing Lymph Node Surgical Intervention in Breast Cancer

Yuan Yuan, MD, PhD, professor, director, Breast Medical Oncology Medicine, medical director, Breast Oncology Disease Research Group, Cedars-Sinai Medical Center, Health Sciences Clinical Professor, University of California, Los Angeles, discusses the potential shift towards minimizing surgical intervention for lymph node management in breast cancer.

Yuan begins by stating that has been a trend towards increasingly minimizing surgical intervention whenever possible in breast cancer management, although ensuring safety remains a top priority. Over the past 5 to 10 years, numerous clinical trials have guided a shift from extensive lymph node dissection to the more conservative approach of sentinel lymph node biopsy (SLNB), according to Yuan. Today, the standard practice for patients with clinically lymph node–negative disease involves performing a SLNB once they complete neoadjuvant chemotherapy and are being prepared for surgery, she explains.

For patients with fewer than 3 positive lymph nodes, there is growing interest in determining whether surgery can be minimized if systemic therapy successfully downstages the nodes, Yuan continues. At an OncLive® State of the Science Summit™ on breast cancer, oncologists highlighted this topic by introducing the concept of targeted lymph node removal. This method focuses on reducing long-term surgical toxicity, such as lymphedema, by limiting the scope of lymph node dissection, she explains. Although this approach is still evolving, it offers the potential to significantly improve patient outcomes by reducing the long-term effects of more invasive surgeries, Yuan expands.

However, a critical gap remains in determining how to treat patients who achieve a complete response following chemotherapy or immunotherapy, she emphasizes. The key question is whether oncologists can safely minimize surgical intervention in these cases without compromising outcomes, Yuan notes. Large datasets and further clinical trials are essential to answer this question, allowing investigators to determine the most effective and least invasive course of action for patients, she concludes.