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Leveraging Neoadjuvant Chemotherapy to Minimize the Burden of Axillary Surgery: a Review of Current Strategies and Surgical Techniques

  • Local-Regional Evaluation and Therapy (A Kong, Section Editor)
  • Published:
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Abstract

Purpose of Review

Axillary nodal disease is significantly less likely in both clinically node-negative (cN0) and node-positive (cN+) breast cancer patients after neoadjuvant chemotherapy (NAC). There have thus been significant efforts to “de-escalate” axillary surgery in this setting. This review discusses modern axillary surgical paradigms and techniques after NAC.

Recent Findings

In cN0 patients, the accuracy and feasibility of sentinel lymph node biopsy (SLNB) after NAC is well-established, with prospective evidence supporting its oncologic safety. SLNB is also acceptable in select cN+ patients when certain criteria are met. There is mounting “real-world” evidence for the technical feasibility of this approach, including various methods of localizing and excising biopsy-proven nodes, with the ability to avoid axillary lymph node dissection in a substantial proportion of patients. However, outcome data is limited to small retrospective series.

Summary

In appropriately selected patients, there is increasing opportunity to leverage the benefits of NAC to minimize the burden of axillary surgery.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Murphy BL, Day CN, Hoskin TL, Habermann EB, Boughey JC. Neoadjuvant chemotherapy use in breast cancer is greatest in excellent responders: triple-native and HER2+ subtypes. Ann Surg Oncol. 2018;25(8):2241–8.

    PubMed  Google Scholar 

  2. Mougalian SS, Soulous PR, Killelea BK, et al. Use of Neoadjuvant chemotherapy for patients with stage I to III breast cancer in the United States. Cancer. 2015;121(15):2544–52.

    PubMed  Google Scholar 

  3. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–72.

    PubMed  Google Scholar 

  4. Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998;16(8):2672–85.

    CAS  PubMed  Google Scholar 

  5. Bear HD, Anderson S, Smith RE, Geyer CE Jr, Mamounas EP, Fisher B, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2006;24(13):2019–27.

    CAS  PubMed  Google Scholar 

  6. Von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab Emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380:617–28.

    Google Scholar 

  7. Masuda N, Lee SJ, Ohtani S, Im YH, Lee ES, Yokota I, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med. 2017;376:2147–59.

    CAS  PubMed  Google Scholar 

  8. Golshan M, Cirrincione CT, Sikov WM, Berry DA, Jasinski S, Weisberg TF, et al. Impact of neoadjuvant chemotherapy in stage II-III triple negative breast cancer on eligibility for breast-conserving surgery and breast conservation rates: surgical results from CALGB 40603 (Alliance). Ann Surg. 2015;262(3):434–9.

    PubMed  PubMed Central  Google Scholar 

  9. Boughey JC, McCall LM, Ballman K, et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) prospective multicenter clinical trial. Ann Surg. 2014;260(4):608–16.

    PubMed  PubMed Central  Google Scholar 

  10. Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al. Sentinel lymph node surgery after Neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Boileau JF, Poirier B, Basik M, Holloway CMB, Gaboury L, Sideris L, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast Cancer: the SN FNAC study. J Clin Oncol. 2015;33:258–64.

    PubMed  Google Scholar 

  12. •• Classe JM, Loaec C, Gimbergues P, et al. Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study. Breast Cancer Res Treat. 2019;173(2):343–52. This prospective study demonstrated acceptable oncologic outcomes in cN0 patients treated with SLNB alone after NAC and evaluated false negative rates of SLNB in cN+ patients.

    PubMed  Google Scholar 

  13. Hunt K, Yi M, Mittendorf E, Guerrero C, Babiera GV, Bedrosian I, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients. Ann Surg. 2009;250(4):558–66.

    PubMed  Google Scholar 

  14. Ashikaga T, Krag DN, Land SR, Julian TB, Anderson SJ, Brown AM, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111–8.

    PubMed  PubMed Central  Google Scholar 

  15. Lucci A, Mackie McCall L, Beitsch PD, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group trial Z0011. J Clin Oncol. 2007;25(24):3657–63.

    PubMed  Google Scholar 

  16. • Nogi H, Uchida K, Mimoto R, et al. Long-term follow-up of node-negative breast cancer patients evaluated via sentinel node biopsy after neoadjuvant chemotherapy. Clin Breast Cancer. 2017;17(8):644–9. This large single-institution series demonstrated acceptable axillary recurrence-free survival in cN0 patients treated with SLNB after NAC.

    PubMed  Google Scholar 

  17. Tan VKM, Goh BKP, Fook-Chong S, Khin LW, Wong WK, Yong WS. The feasibility and accuracy of sentinel lymph node biopsy in clinically node-negative patients after neoadjuvant chemotherapy for breast cancer – a systematic review and meta-analysis. J Surg Oncol. 2011;104(1):97–103.

    PubMed  Google Scholar 

  18. van der Heiden-van der Loo M, de Munck L, Sonke G, et al. Population based study on sentinel node biopsy before or after neoadjuvant chemotherapy in clinically node negative breast cancer patients: identification rate and influence on axillary treatment. Eur J Cancer. 2015;51(8):915–21.

    Google Scholar 

  19. National Comprehensive Cancer Network. Breast Cancer (Version 5.2020). https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed July 15, 2020.

  20. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Donker M, van Tiehnhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10.

    PubMed  PubMed Central  Google Scholar 

  22. Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al. IBCSG 23-01 randomised controlled trial comparing axillary dissection versus no axillary dissection in patients with sentinel node micrometastases. Lancet Oncol. 2013;14(4):297–305.

    PubMed  PubMed Central  Google Scholar 

  23. Klintman M, Buus R, Cheang MCU, Sheri A, Smith IE, Dowsett M. Changes in expression of genes representing key biologic processes after neoadjuvant chemotherapy in breast cancer, and prognostic implications in residual disease. Clin Cancer Res. 2016;22(1):2405–16.

    CAS  PubMed  Google Scholar 

  24. • Wong SM, Almana N, Choi J, et al. Prognostic significance of residual axillary nodal micrometastases and isolated tumor cells after neoadjuvant chemotherapy for breast cancer. Ann Surg Oncol. 2019;26(11):3502–9. This series used both single-institution and population-based data from the National Cancer Database to demonstrate that, unlike in upfront surgery patients, isolated tumor cells and micrometastases after NAC are associated with worse survival compared to negative lymph nodes.

    PubMed  Google Scholar 

  25. Barron AU, Hoskin TL, Boughey JC. Predicting non-sentinel lymph node metastases in patients with a positive sentinel lymph node after neoadjuvant chemotherapy. Ann Surg Oncol. 2018;25(10):2867–74.

    PubMed  Google Scholar 

  26. • Moo TA, Edelweiss M, Hajiyeya S, et al. Is low-volume disease in the sentinel node after neoadjuvant chemotherapy an indication for axillary dissection? Ann Surg Oncol. 2018;25(6):1488–94. This single-institution series found high rates of non-sentinel lymph node metastases at time of axillary dissection, even for low-volume sentinel node disease after NAC, highlighting that residual nodal disease after NAC may have different implications than in upfront surgery patients.

    PubMed  PubMed Central  Google Scholar 

  27. Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14:609–18.

    PubMed  Google Scholar 

  28. Mamtani A, Barrio AV, King TA, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a Prospective Study. Ann Surg Oncol. 2016;23(100):3467–74.

    PubMed  PubMed Central  Google Scholar 

  29. Laws A, Hughes ME, Hu J, Barry WT, Dominici L, Nakhlis F, et al. Impact of residual nodal disease burden on technical outcomes of sentinel lymph node biopsy for node-positive (cN1) breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol. 2019;26(12):3846–55.

    PubMed  Google Scholar 

  30. Boughey JC, Ballman KV, Le-Petross HT, et al. Identification and resection of clipped node decreases the false-negative rate of sentinel lymph node surgery in patients presenting with node-positive breast cancer (T0-T4, N1-N2) who receive neoadjuvant chemotherapy: results from ACOSOG Z1071 (Alliance). Ann Surg. 2016;263(4):802–7.

    PubMed  PubMed Central  Google Scholar 

  31. Caudle A, Yang W, Krishnamurthy S, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol. 2016;34(10):1072–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Siso C, de Torres J, Esqueva-Colmenarejo A, et al. Intraoperative ultrasound-guided excision of axillary clip in patients with node positive breast cancer treated with neoadjuvant therapy (ILINA trial): a new tool to guide the excision of the clipped node after neoadjuvant treatment. Ann Surg Oncol. 2018;25(3):784–91.

    PubMed  Google Scholar 

  33. Diego E, McAuliffe P, Soran A, et al. Axillary staging after neoadjuvant chemotherapy for breast cancer: a pilot study combining sentinel lymph node biopsy with radioactive seed localization of pre-treatment positive axillary lymph nodes. Ann Surg Oncol. 2016;23(5):1549–53.

    PubMed  Google Scholar 

  34. Cabıoğlu N, Karanlık H, Kangal D, et al. Improved false-negative rates with intraoperative identification of clipped nodes in patients undergoing sentinel lymph node biopsy after neoadjuvant chemotherapy. Ann Surg Oncol. 2018;25(10):3030–6.

    PubMed  Google Scholar 

  35. Allweiss TM, Menes T, Rotbar N, et al. Ultrasound guided tattooing of axillary lymph nodes in breast cancer patients prior to Neoadjuvant therapy, and identification of tattooed nodes at the time of surgery. Eur J Surg Oncol. 2020;46(6):1041–5.

    Google Scholar 

  36. Natsiopoulos I, Intzes S, Liappis T, Zarampoukas K, Zarampoukas T, Zacharopoulou V, et al. Axillary lymph node tattooing and targeted axillary dissection in breast cancer patients who presented as cN+ before neoadjuvant chemotherapy and became cN0 after treatment. Clin Breast Cancer. 2019;19(3):208–15.

    PubMed  Google Scholar 

  37. Donker M, Straver ME, Wesseling J, Loo CE, Schot M, Drukker CA, et al. Marking axillary lymph nodes with radioactive iodine seeds for axillary staging after neoadjuvant systemic treatment in breast cancer patients: the MARI procedure. Ann Surg. 2015;261(2):378–82.

    PubMed  Google Scholar 

  38. • Van Nijnatten TJA, Simons JM, Smidt ML, et al. A novel less-invasive approach for axillary staging after neoadjuvant chemotherapy in patients with axillary node-positive breast cancer by combining Radioactive Iodine Seed Localization in the Axilla With the Sentinel Node Procedure (RISAS): a Dutch prospective multicenter validation study. Clin Breast Cancer. 2017;17(5):399–402. This ongoing multicenter study will prospectively evaluate the accuracy of performing both SLNB and MARI in cN+ patients after NAC.

    PubMed  Google Scholar 

  39. Nguyen TT, Hiken TJ, Glazebrook KN, Boughey JC. Localizing the clipped node in patients with node-positive breast cancer treated with Neoadjuvant chemotherapy: early learning experience and challenges. Ann Surg Oncol. 2017;24(10):3011–6.

    PubMed  Google Scholar 

  40. Hartmann S, Reimer T, Gerber B, Stubert J, Stengel B, Stachs A. Wire localization of clip-marked axillary lymph nodes in breast cancer patients treated with primary systemic therapy. Eur J Surg Oncol. 2018;44(9):1307–11.

    PubMed  Google Scholar 

  41. Plecha D, Bai S, Patterson H, Thompson C, Shenk R. Improving the accuracy of axillary lymph node surgery in breast cancer with ultrasound-guided wire localization of biopsy proven metastatic lymph nodes. Ann Surg Oncol. 2015;22(13):4241–6.

    PubMed  Google Scholar 

  42. Greenwood HI, Wong JM, Mukhtar RA, Alvarado MD, Price ER. Feasibility of magnetic seeds for preoperative localization of axillary lymph nodes in breast cancer treatment. AJR Am J Roentgenol. 2019;213(4):953–7.

    PubMed  Google Scholar 

  43. Taback B, Jadeja P, Ha R. Enhanced axillary evaluation using reflector-guided sentinel lymph node biopsy: a prospective feasibility study and comparison with conventional lymphatic mapping techniques. Clin Breast Cancer. 2018;18(5):e869–74.

    PubMed  Google Scholar 

  44. • Laws A, Dillon K, Kelly BN, Kantor O, Hughes KS, Gadd MA, et al. Node-positive patients treated with neoadjuvant chemotherapy can be spared axillary lymph node dissection with wireless non-radioactive localizer. Ann Surg Oncol. 2020. This is one of the largest single-institution series evaluating technical feasibility of excising biopsy-proven axillary lymph nodes using non-radioactive localizers;27:4819–27.

    PubMed  Google Scholar 

  45. Park S, Koo JS, Kim GM, Sohn J, Kim SI, Cho YU, et al. Feasibility of charcoal tattooing of cytology-proven metastatic axillary lymph node at diagnosis and sentinel lymph node biopsy after Neoadjuvant chemotherapy in breast cancer patients. Cancer Res Treat. 2018;50(3):801–12.

    CAS  PubMed  Google Scholar 

  46. • Patel R, MacKerricher W, Tsai J, et al. Pretreatment tattoo marking of suspicious axillary lymph nodes: reliability and correlation with sentinel lymph node. Ann Surg Oncol. 2019;26(8):2452–8. This is one of the largest single-institution series evaluating technical feasibility of excising biopsy-proven axillary lymph nodes using tattoo marking.

    PubMed  Google Scholar 

  47. Boughey JC, Ballman KV, Hunt KK, McCall LM, Mittendorf EA, Ahrendt GM, et al. Axillary ultrasound after neoadjuvant chemotherapy and its impact on sentinel lymph node surgery: results from the American College of Surgeons Oncology Group Z1071 trial (Alliance). J Clin Oncol. 2015;33(30):3386–93.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. • Schwentner L, Helms G, Nekljudova V, et al. Using ultrasound and palpation for predicting axillary lymph node status following neoadjuvant chemotherapy – results from the multi-center SENTINA trial. Breast. 2017;31:202–7. In this retrospective analysis of a large prospective cohort of cN+ patients who underwent SLNB and ALND after NAC, axillary ultrasound after NAC had inadequate positive predictive value for pathologic axillary disease, and is therefore an unacceptable method for selecting patients who require ALND.

    PubMed  Google Scholar 

  49. Morency D, Dumitra S, Parvez E, Martel K, Basik M, Robidoux A, et al. Axillary lymph node ultrasound following neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: results from the SN FNAC study. Ann Surg Oncol. 2019;26(13):4337–45.

    PubMed  Google Scholar 

  50. • Moo TA, Jochelson MS, Zabor EC, et al. Is clinical exam of the axilla sufficient to select node-positive who downstage after NAC for SLNB? A comparison of the accuracy of clincial exam versus MRI. Ann Surg Oncol. 2019;26(13):4238–43. In this single-institution series of cN+ patients treated with NAC, MRI after NAC had inadequate positive predictive value for pathologic axillary disease, and is therefore an unacceptable method for selecting patients who require ALND.

    PubMed  Google Scholar 

  51. Ha SM, Cha JH, Kim HH, Shin HJ, Chae EY, Choi WJ. Diagnostic performance of breast ultrasonography and MRI in the prediction of lymph node status after neoadjuvant chemotherapy for breast cancer. Acta Radiol. 2017;58(10):1198–205.

    PubMed  Google Scholar 

  52. Mattingly AE, Mooney B, Lin HY, Kiluk JV, Khakpour N, Hoover SJ, Laronga C, Lee MC. Magnetic resonance imaging for axillary breast cancer metastasis in the neoadjuvant setting: a prospective study. Clin Breast Cancer. 2017;17(3):180–187.

  53. Fayanju OM, Ren Y, Greenup RA, Plichta JK, Rosenberger LH, Force J, et al. Extent of axillary surgery in inflammatory breast cancer: a survival analysis of 3500 patients. Breast Cancer Res Treat. 2020;180(1):207–17.

    CAS  PubMed  Google Scholar 

  54. Park TS, Thomas SM, Rosenberger LH, Fayanju OM, Plichta JK, Blitzblau RC, et al. The association of extent of axillary surgery and survival in women with N2-3 invasive breast cancer. Ann Surg Oncol. 2018;25(10):3019–29.

    PubMed  PubMed Central  Google Scholar 

  55. DeSnyder SM, Mittendorf EA, Le-Petross C, et al. Prospective feasibility trial of sentinel lymph node biopsy in the setting of inflammatory breast cancer. Clin Breast Cancer. 2018;18(1):e73–7.

    PubMed  Google Scholar 

  56. Hidar S, Bibi M, Gharbi O, Tebra S, Trabelsi A, Korbi S, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy in inflammatory breast cancer. Int J Surg. 2009;7:272–5.

    PubMed  Google Scholar 

  57. Stearns V, Ewing CA, Slack R, Penannen MF, Hayes DF, Tsangaris TN. Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol. 2002;9:235–42.

    PubMed  Google Scholar 

  58. Caudle AS, Bedrosian I, Milton DR, DeSnyder SM, Kuerer HM, Hunt KK, et al. Use of sentinel lymph node dissection after neoadjuvant chemotherapy in patients with node-positive breast cancer at diagnosis: practice patterns of American Society of Breast Surgeons members. Ann Surg Oncol. 2017;24(10):2925–34.

    PubMed  PubMed Central  Google Scholar 

  59. Vugts G, Maaskant-Braat AJ, de Roos WK, et al. Management of the axilla after neoadjuvant chemotherapy for clinically node positive breast cancer: a nationwide survey study in The Netherlands. Eur J Surg Oncol. 2016;42(7):956–64.

    CAS  PubMed  Google Scholar 

  60. Lee SB, Yu JH, Park H, Kim HJ, Park SH, Chae BJ, et al. Sentinel node biopsy after neoadjuvant chemotherapy for breast cancer with axillary node metastasis: a survey of clinical practice. Asian J Surg. 2019;42(1):314–9.

    PubMed  Google Scholar 

  61. Wong SM, Weiss A, Mittendorf EA, King TA, Golshan M. Surgical management of the axilla in clinically node-positive patients receiving neoadjuvant chemotherapy: a National Cancer Database analysis. Ann Surg Oncol. 2019;26(11):3517–25.

    PubMed  Google Scholar 

  62. • Montagna G, Mamtani A, Knezevic A, Brogi E, Barrio AV, Morrow M. Selecting node-positive patients for axillary downstaging with neoadjuvant chemotherapy. Ann Surg Oncol. 2020;27(11):4515–4522. This is one of the largest single-institution series using SLNB in cN+ patients after NAC, demonstrating the ability to avoid ALND in a substantial proportion of patients and identifying factors associated with highest likelihood of ALND omission.

  63. ClinicalTrials.gov. Bethesda (MD): National Library of Medicine. Comparison of axillary lymph node dissection with axillary radiation for patients with node-positive breast cancer treated with chemotherapy. https://clinicaltrials.gov/ct2/show/NCT01901094. Accessed July 15, 2020.

  64. Martelli G, Miceli R, Folli S, Guzzetti E, Chifu C, Maugeri I, et al. Sentinel node biopsy after primary chemotherapy in cT2 N0/1 breast cancer patients: long-term results of a retrospective study. Eur J Surg Oncol. 2017;43(11):2012–20.

    CAS  PubMed  Google Scholar 

  65. Galimberti V, Ribeiro Fontana SK, Maisonneuve P, Steccanella F, Vento AR, Intra M, et al. Sentinel node biopsy after neoadjuvant treatment in breast cancer: five-year follow-up of patients with clinically node-negative or node-positive disease before treatment. Eur J Surg Oncol. 2016;42:361–8.

    CAS  PubMed  Google Scholar 

  66. Chang JM, Kosiorek HE, Wasif N, Gray RJ, Stucky CCH, Northfelt DW, et al. The success of sentinel lymph node biopsy after neoadjuvant therapy: a single institution review. Am J Surg. 2017;214(6):1096–101.

    PubMed  Google Scholar 

  67. Park S, Lee JE, Paik HJ, Ryu JM, Bae SY, Lee SK, et al. Feasibility and prognostic effect of sentinel lymph node biopsy after neoadjuvant chemotherapy in cytology-proven, node-positive breast cancer. Clin Breast Cancer. 2017;17(1):e19–29.

    PubMed  Google Scholar 

  68. • Kang YJ, Han W, Park S, et al. Outcome following sentinel lymph node biopsy-guided decisions in breast cancer patients with conversion from positive to negative axillary lymph nodes after neoadjuvant chemotherapy. Breast Cancer Res Treat. 2017;1566:473–80. This is one of the largest single-institution series evaluating oncologic outcomes in cN+ patients treated with SLNB followed by ALND only for a positive SLNB, and demonstrating acceptable regional and distant recurrence rates.

    Google Scholar 

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  1. Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA

    Alison Laws & Michelle C. Specht

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Laws, A., Specht, M.C. Leveraging Neoadjuvant Chemotherapy to Minimize the Burden of Axillary Surgery: a Review of Current Strategies and Surgical Techniques. Curr Breast Cancer Rep 12, 317–325 (2020). https://doi.org/10.1007/s12609-020-00388-7

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