Critical dialogue: recent advancements toward omission of axillary lymph node dissection in clinically node positive breast cancer patients treated with neoadjuvant chemo-immuno therapy: impact on radiology practice

Less invasive restaging procedures, compared to axillary lymph node dissection (ALND), have become the standard of care in clinically node positive (cN+) breast cancer patients treated with neoadjuvant systemic therapy (NST) in most institutions]. Due to the therapeutic effects of NST, initial cN+ patients can achieve an axillary pathologic complete response (pCR) and are thought not to benefit from an ALND. Less invasive restaging aims to reduce surgical morbidity related to ALND but carries the risk of a false negative outcome (i.e., absence of cancer cells in resected axillary lymph nodes but presence of cancer cells in remaining axillary lymph nodes). The diagnostic accuracy of various less invasive restaging procedures has been studied and showed different false negative rates (FNR). Although ...