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Surgical Management of Operable Breast Cancer After Neoadjuvant Systemic Therapy

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Breast Disease

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Abstract

The primary goal of neoadjuvant chemotherapy (NCT) in operable breast cancer is tumor down-sizing to facilitate breast-conserving surgery (BCS). The use of NCT in early-stage breast cancer in carefully selected patients is increasing. Despite a shift in the treated patient population to patients with earlier-stage tumors, the principles of surgery after NCT remain the same. Monitoring response to therapy is important for surgical planning and prognostic information. Preoperative marking of the tumor is essential for guiding BCS after NCT and should be performed in all patients. Axillary staging can be performed prior to or after NCT, and both methods are associated with specific risks and benefits. Early literature supported the use of pre-NCT sentinel lymph node biopsy (SLNB), but current literature suggests increased accuracy and decreased use of axillary dissection in patients who undergo SLNB after NCT. A multidisciplinary approach to breast cancer care is essential during NCT for improved outcomes and decreased morbidity.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, Magee-Women’s Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Atilla Soran MD, MPH, FACS

  2. Department of Surgery, Division of Surgical Oncology, University of Pittsburgh School of Medicine, Magee-Women’s Hospital, University of Pittsburgh Medical Center, 300 Halket St, Suite 2601, Pittsburgh, PA, USA

    Ebru Menekse MD

  3. Surgical Oncology Department, Breast Surgery Unit, Magee-Women’s Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Ebru Menekse MD

  4. Department of Surgery, Division of Surgical Oncology, University of North Carolina School Lineberger Comprehensive Cancer Center, 170 Manning Dr., CB# 7203, Chapel Hill, NC, USA

    Kandace P. McGuire MD

  5. Department of Surgery, University of North Carolina, Lineberger Comphrensive Cancer Center, Chapel Hill, NC, USA

    Kandace P. McGuire MD

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  1. Atilla Soran MD, MPH, FACS
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  2. Ebru Menekse MD
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  3. Kandace P. McGuire MD
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Correspondence to Atilla Soran MD, MPH, FACS .

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Editors and Affiliations

  1. Inst of Oncology,Ist Tıp Fak, Istanbul University, Istanbul, Turkey

    Adnan Aydiner

  2. General Surgery, Istanbul Univ Istanbul Fac of Med, Istanbul, Turkey

    Abdullah İgci

  3. Breast Surgery,, Magee-Womens Hospital, Pittsburg, USA

    Atilla Soran

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Soran, A., Menekse, E., McGuire, K.P. (2016). Surgical Management of Operable Breast Cancer After Neoadjuvant Systemic Therapy. In: Aydiner, A., İgci, A., Soran, A. (eds) Breast Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-26012-9_17

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