Behind The Knife: The Surgery Podcast Behind the Knife General Surgery Oral Board Review – Sample Episode 9 - Axillary Management of Breast Cancer
Aug 12, 2025
In this session, a Case Presenter and Surgical Educator discusses a challenging breast cancer case, providing insights into the management of node-positive triple negative disease. They cover essential topics like initial staging workup, the importance of genetic counseling, and the role of neoadjuvant chemotherapy. The conversation delves into surgical strategies after treatment response, focusing on sentinel node biopsy and the necessity for completion axillary dissection in cases of residual disease. This practical commentary is invaluable for surgical trainees.
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Systemic Staging For Node-Positive TNBC
- Triple-negative breast cancer with nodal metastasis is best staged with CT chest/abdomen/pelvis and a bone scan.
- PET-CT is an acceptable alternative for systemic staging.
Use Neoadjuvant Chemo For Larger Or Node-Positive Tumors
- Give neoadjuvant chemotherapy for triple-negative or HER2-positive cancers >2 cm or with positive nodes.
- Neoadjuvant therapy can enable breast conservation and may avoid axillary dissection if nodes respond.
Offer Genetic Testing Broadly When Indicated
- Refer patients meeting criteria (e.g., triple-negative, young age) for genetic testing because results change surgical and systemic management.
- When uncertain about criteria, offer testing since it impacts treatment and family cascade testing.