Local management after neoadjuvant treatment for breast cancer

Neoadjuvant chemotherapy (NAC) was originally used in patients with locally advanced breast cancer. Then, it is used in operable breast cancer to downstage the primary breast cancer and axillary lymph nodes metastasis, result in improving the cosmetic outcome and decreasing surgical morbidity. However, it is sometimes difficult to assess the extent of residual disease after NAC, as the NAC reduces the lesion and obscure the original images both breast and axilla. Thus, detailed assessment of primary breast cancer and axillary lymph nodes metastasis are required from the time of before NAC until the time of surgery. These assessments include the accurate location, the extent of intraductal component around primary tumor and the axillary nodal status. Multimodality imaging with intervention for cytopathology can help to delineate the size and location of breast cancer and lymph node metastasis and predict the residual tumor burden in primary breast cancer and involved axillary nodes. In the future, with development of new targeted therapy, technologies in medical imaging diagnosis and ongoing trial data will provide further individualized treatment option for patients with breast cancer. This article reviews the current evidence and management recommendations for optimal surgical treatment in this setting.