title: Lymphatic mapping and sentinel lymphadenectomy prior to neoadjuvant chemotherapy in patients with large breast cancers.
abstract: BACKGROUND
  Lymphatic mapping and sentinel lymphadenectomy (LM/SL) accurately evaluates the axilla in patients with small breast cancers. LM/SL in patients with large breast cancers is controversial. We examined the accuracy of LM/SL prior to neoadjuvant chemotherapy in patients with large (>3.5 cm) breast cancers.
  
  
  METHODS
  Patients with large breast cancers underwent LM/SL prior to neoadjuvant chemotherapy using 99m-technetium radiocolloid and isosulfan-blue dye technique.
  
  
  RESULTS
  Twenty-one patients with large (median 5.0 cm) breast cancers underwent LM/SL prior to neoadjuvant chemotherapy. Twelve patients had a tumor-free sentinel node (SN) and received doxorubicin-based chemotherapy; 9 patients had disease in the SN and received doxorubicin followed by a taxane. No patient progressed while receiving neoadjuvant chemotherapy, nor has there been an axillary recurrence (median 36 months).
  
  
  CONCLUSIONS
  LM/SL performed prior to neoadjuvant chemotherapy in patients with large breast cancers is an accurate method of axillary staging. Axillary staging prior to neoadjuvant chemotherapy may have prognostic and therapeutic implications.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, NC 27599, USA. David_Ollila@med.unc.edu
authors.forename: David W
authors.initials: DW
authors.lastname: Ollila
authors.forename: Heather B
authors.initials: HB
authors.lastname: Neuman
authors.forename: Carolyn
authors.initials: C
authors.lastname: Sartor
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Carey
authors.forename: Nancy
authors.initials: N
authors.lastname: Klauber-Demore
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010347:Patient Care Planning; D012680:Sensitivity and Specificity