FACTORS IN CARCINOMA BREAST PATIENTS POST-NEOADJUVANT THERAPY DETERMINING LYMPH NODE DISSECTION LEVELS: INSIGHTS FROM A REGIONAL CANCER CENTER IN EASTERN INDIA

Background and Objectives: Breast cancer is the most common cancer worldwide as well as India. According to Globocon 2020 data, breast cancer constitutes 11.7 % of all cancer cases and is the fourth most common cause for cancer mortality in the world. In addition, the situation is equally alarming in India with breast cancer constituting 13.5 % of all cancers and being the most common cause of cancer mortality in India.Primary objective of this article is to study factors in post Neoadjuvant Therapy patients of Carcinoma Breast to determine the level of Lymph Node Dissection. Methods: A single institute prospective study that included all the patients who underwent definitive surgery (MRM with SLNB with Level 1,2 and 3 LN dissection) for Breast cancer (post Neoadjuvant Therapy) with clinically node negative axilla post Neoadjuvant Therapy from 1st March 2021- 28th February 2023 . At the end of study, patients with positive lymph nodes were analysed for the factors that can predict the lymph node positivity, sensitivity, and specificity of blue dye only technique for SLNB in post NAT patients Results: Total 48 patients underwent surgery. Mean age of the patients was 46.5±8.7 years and median age was 45 years. SLN identification rate was 89.6%. In this study, we found that pathological complete response in breast tumour was significantly associated with complete pathological response in axillary lymph nodes. Patients with non-luminal subtype such as triple negative breast cancer had significant association with axillary lymph node pathological complete response. Conclusion: Patients who are clinically N1 disease and become clinically node negative after neoadjuvant therapy and belonging to non luminal subtype have more chances of nodal PCR and so can be considered for sentinel dye technique to determine the level of lymph node dissection and hence to taper the axillary surgery and reduce morbidity, however blue only dye technique is not recommended due to high false negative rates.