the days of axillary lymph node dissection in her2+ patients may be numbered,at least

[Lani]

unfortunately when I read the whole article, the do not recommend changing treatment protocols until a randomized clinical trial proves that ALND is not necessary in those treated with neoadjuvant chemo+herceptin who achieve a pCR.

They go on to say:

Another alternative to axillary lymph node dissec- tion is intraoperative lymphatic mapping and sentinel lymph node biopsy. The findings presented in the current study suggest that it may be feasible to perform intraoper- ative lymphatic mapping and sentinel lymph node biopsy in patients with clinical complete response to trastuzu- mab-containing neoadjuvant chemotherapy. Patients treated with trastuzumab-containing neoadjuvant chemo- therapy have a 74% chance of achieving an axillary pCR, and therefore complete axillary lymph node dissection represents overtreatment for many of these patients. Lym- phatic mapping and sentinel lymph node biopsy is increasingly being performed by surgeons in patients who receive neoadjuvant chemotherapy and present with an initially clinically negative axilla to guide further therapy of the axilla.16 However, there have been conflicting sin- gle-institution reports regarding the feasibility and accu- racy of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients who present with initial biopsy- proven axillary metastases.17-19 To address this issue, the American College of Surgeons Oncology Group has just opened a clinical trial (ACOSOG Z1071) to investigate the accuracy of lymphatic mapping and sentinel lymph node biopsy in patients who present with biopsy-proven axillary lymph node metastasis and undergo neoadjuvant chemotherapy. As better systemic agents are introduced into the breast cancer armamentarium, it will be critically important to develop minimally invasive and less morbid surgical approaches to the axilla in patients treated with neoadjuvant chemotherapy.