Can a seed-sized tool from Texas spare clinically node positive breast cancer patients from a complete axillary dissection?

Axillary lymph node status guides both treatment course and prognosis in patients with breast cancer. When patients receiving neoadjuvant chemotherapy (NAC) are excluded, NCCN guidelines call for a sentinel node (SN) biopsy in clinically node negative stage I and II patients, followed by complete axillary lymph node dissection (ALND) only if there is a SN metastasis and the patient does not meet eligibility criteria for the ACOSOG Z0011 trial (1). In the remainder, ALND can be omitted. Testing whether this concept can be extended to patients diagnosed pre-operatively as both node positive and scheduled to receive NAC has been the subject of multiple investigations; their impetus being the desire to reduce ALND and its attendant morbidity (2-6).