SLNB or ALND after Neoadjuvant Therapy - Your Experiences?

hoosier238

Hello all. My mother was diagnosed with T3N1M0 BC in the right breast in December. The molecular typing was ER+/PR-/HER2+. She received 6 cycles of NAC TCHP (and is continuing with H/P for one year). The response has been very good with little or no residual cancer left (we'll know more after the surgical pathology, of course). In particular, the axilla seems to be clean (the nodes which were initially palpable are no longer palpable, and imaging does not indicate cancer in the axilla).

One decision we have to make is the surgical management of the axilla: SLNB or ALND. The NCCN guidelines state that "Axilla may be restaged after preoperative systemic therapy...SLNB or ALND can be performed if axilla is clinically negative." After NAC, the false negative rate for SLNB is significantly higher than if surgery had been done before systemic therapy (see the SENTINA and Z1071 trials). "Among patients shown to be node-positive prior to preoperative systemic therapy, SLNB has a >10% false-negative rate when performed after preoperative systemic therapy. This rate can be improved by marking biopsied lymph nodes to document their removal, using dual tracer, and by removing more than 2 sentinel nodes."

Has anyone else faced this decision? Did you receive SLNB or ALND? Were you happy with your decision? Thanks!