TY - CHAP M1 - Book, Section TI - Management of the Pathologically Positive Axilla A1 - Newman, Lisa A. A2 - Morita, Shane Y. A2 - Balch, Charles M. A2 - Klimberg, V. Suzanne A2 - Pawlik, Timothy M. A2 - Posner, Mitchell C. A2 - Tanabe, Kenneth K. Y1 - 2018 N1 - T2 - Textbook of Complex General Surgical Oncology AB - A generally accepted tenet of management of solid tumor malignancies—including adenocarcinoma of the breast—is that most bulky/clinically evident sites of disease are best managed by surgical resection, with radiation treatment reserved for microscopic, clinically occult foci of soft tissue disease. The goal of systemic therapy is to eradicate distant organ disease. Clearly, however, there will be overlap in the results achieved by these modalities of cancer care, and these effects can influence the extent of necessary surgery as well as the sequence of delivering these components of cancer care. For example, a patient that initially presents with bulky axillary lymph nodes will likely require an anatomically defined level I/II axillary lymph node dissection, and this surgery may be performed as initial primary treatment as long as there is no evidence of unresectable disease that would place the axillary neurovascular structures at risk for intraoperative damage. However, these patients will routinely require chemotherapy because the axillary disease reflects an increased likelihood of harboring distant organ micrometastatic disease, even in the presence of negative body imaging. These cases, therefore, become very strong candidates for receiving preoperative/neoadjuvant chemotherapy, which can also downstage the extent of the axillary disease. Whether or not axillary downstaging by neoadjuvant chemotherapy can diminish the extent of axillary surgery, and make the patient a candidate for axillary sentinel lymph node biopsy alone is an ongoing subject of debate in the oncology literature. At the other end of the spectrum, patients with low-volume disease in the axilla that is detected by a staging procedure (such as sentinel lymph node biopsy or axillary ultrasound and sono-guided needle biopsy) will typically receive adjuvant chemotherapy therapy, and the locoregional effects of systemic therapy coupled with radiation may be adequate in replacing the need for a completion axillary lymph node dissection in selected cases. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1145760655 ER -