title: Axillary-conserving surgery is facilitated by neoadjuvant chemotherapy of breast cancer.
abstract: BACKGROUND
  This study examines the downstaging of breast cancer axillary lymph node (ALN) metastasis by neoadjuvant chemotherapy (NCT) and the potential facilitation of axillary-conserving surgery.
  
  
  METHODS
  Records of breast cancer patients treated with NCT, breast surgery, and pathological ALN assessment were reviewed using the institutional breast cancer database.
  
  
  RESULTS
  Of 473 cases, 309 (65%) were clinically ALN-positive (cN+) and 164 (35%) were clinically ALN-negative (cN-). Pre-NCT, needle biopsy, sentinel lymph node (SLN) biopsy, or axillary dissection documented metastasis in 94% (117/124) of cN+ and 27% (13/49) of cN- patients tested. Pathological complete response of ALNs to NCT was documented in 36% (41/115) of patients. False negative SLN biopsy following NCT occurred in 4% of cases (1/28).
  
  
  CONCLUSIONS
  NCT downstages primary breast cancer and ALN metastasis. ALN and SLN biopsy following, rather than before, NCT facilitate both breast- and axillary-conserving surgery.
authors.affiliation: Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA. david.beatty@swedish.org
authors.forename: J David
authors.initials: JD
authors.lastname: Beatty
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Precht
authors.forename: Kimberly
authors.initials: K
authors.lastname: Lowe
authors.forename: Mary
authors.initials: M
authors.lastname: Atwood