Axillary Management after Neoadjuvant Chemotherapy in Breast Cancer: A Survey by Brazilian Society of Mastology.

e12609 Background: Several trials have been investigating the accuracy of sentinel lymph node biopsy (SLNB) in clinically node-positive breast cancer patients undergoing neoadjuvant chemotherapy (NAC). A survey of breast surgeons was performed to assess the current management of axilla after NAC in Brazilian clinical practice. Methods: Brazilian Society of Breast Surgeons members were invited by email to complete an anonymous online survey. From 2000 eligible members, 426 (21.3%) members responded the survey. Results were summarized as proportions based on the number of responses to each question. Results: The majority of responders, 43.4%, indicated performing routine axillary staging by physician exam, ultrasound and PAAF (if necessary) in patients who are to undergo neoadjuvant chemotherapy. Approximately 43% of responders perform SLNB instead of ALND in patients with N1 axillary involvement before neoadjuvant chemotherapy, however many breast surgeons also indicated SLNB for N2 (27.7%) and N3 (18.8%) patients. Axillary complete pathologic response (ypN0) is necessary to omit ALND for 42.8% of responders and 19.5% do not perform ALND in patients getting ypN1is+ (isolated tumoral cells). Considering the option with patients getting ypN1is+ (isolated tumoral cells) and ypN1mic (micrometastases), 24.5% reported not performing ALND after SLND. Fifty-eight participants, 13.8%, accepted only SLNB in patients getting ypN1is+ (isolated tumoral cells), ypN1mic (micrometastases) and ypN1. The molecular profiling of breast tumor is considered when choosing axillary management after neoadjuvant chemotherapy for 26.3% of responders and for 73.7% the molecular profiling is not influencing the decision. Conclusions: Our survey highlighted the trend toward de-escalation of axillary surgery in patients undergoing neoadjuvant treatment and a high heterogeneity in axillary management after chemotherapy in Brazilian practice.