My presentation later today is going to be about sentinel lymph node biopsies following neoadjuvant chemotherapy for breast cancer patients. As you will know, sentinel lymph node biopsy is a standard procedure for patients who undergo breast cancer surgery prior to neoadjuvant chemotherapy and there is this other setting when patients, for a certain reason, for down-staging for downsizing, they will require neoadjuvant preoperative chemotherapy. Sentinel node biopsy can still be performed and it has certain advantages such as sparing the complications relating to axillary lymph node clearances. Complications with axillary lymph node clearances are quite high, 30-40%, such as lymphedema. With a sentinel lymph node biopsy patients will have far less, around 6%, this is why it is so important to keep this procedure as an option for those patients who require neoadjuvant chemotherapy.

The reason why this is a little bit of a more challenging area of cancer surgery is because it was supposed that patients who have more advanced disease, perhaps with involved lymph nodes, and they receive neoadjuvant chemotherapy that sentinel lymph node biopsy performed after neoadjuvant chemotherapy might not be that reliable. Studies have shown that the method is efficient, it can be performed after neoadjuvant chemotherapy even for patients who previously had been node positive. There is also the technique of targeted axillary dissection which can be associated with the sentinel lymph node biopsy in order to increase the identification rates and to avoid any false negatives.

It is already, I would say, standard of care for those patients who are node negative prior to neoadjuvant chemotherapy and they can have sentinel lymph node biopsy with a low false negative rate and high identification rate. For those patients who are positive before neoadjuvant chemotherapy and they become negative following neoadjuvant chemotherapy the method can be safely performed, it is feasible. The added value of the targeted axillary dissection is something which we have to count really.