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Introduction: The identification and biopsy of the sentinel lymph node (SLNB) in breast cancer patients requiring neoadjuvant cytostatic treatment (NAC), with clinically negative lymph nodes following treatment, may be an effective method of de-escalation of axillary surgery. Materials and methods: This prospective study includes 47 cases of breast cancer stage IIB-IIIA, with NAC treatment and complete axillary clinical and imaging response, surgeries performed at Prof. Dr. Alexandru Trestioreanu Oncological Institute in Bucharest (IOB) by the same team. In all the cases, SLNB was employed using the radioactive tracer method. The SLNB technique with Tc99 radioactive tracer involves: - injection of the radioactive tracer and preoperative lymphoscintigraphy, - intraoperative identification of the sentinel node/ lymph nodes and their excisional biopsy, - intraoperative histopathological examination, in paraffin blocks, and immunohistochemistry of the lymph node (SLN). Results: SLN was identified in 46 of 47 cases. In 19 cases SLN was positive, and in 2 cases we recorded false negative results. All patients underwent standard axillary lymphadenectomy (back-up lymphadenectomy). The correlation between the intraoperative and paraffin histopathological examination of SLN with the paraffin and immunohistochemical examination of the rest of the axillary nodes (N-SLN) led to the following results: sensitivity 91% (19/ 21), specificity 100% (25/ 25), positive predictive value 100% (19/ 19), negative predictive value 93% (25/ 27). The accuracy of the method was 96% (44/ 46). SLN invasion was more common in patients with residual tumor 2 cm (vs T 2 cm) (p = 0.01), positive N-SLN (vs non-invaded N-SLN) (p = 0.003). N-SLNs were more frequently invaded when there was peritumoral lymphocyte invasion (vs. no invasion) (p = 0.01). Conclusions: SLNB in patients with breast cancer who require NAC, with clinically and imaging negative lymph nodes following treatment, has a high rate of specificity and an acceptable number of false negative results. Node invasion is more common in patients with residual tumors 2 cm, with lymphovascular invasion or with multicenter/ multifocal disease.

Axillary lymph node dissection (ALND) was and still is an important part of breast cancer treatment despite the fact the sentinel lymph node biopsy (SLNB) has revolutionized breast cancer surgery. SLNB provides the same prognostic information as ALND but with significantly less morbidity. The results of numerous trials conducted over the past 20 years have crowned SLNB as the gold standard for early breast cancer treatment. ALND represents a very standardized intervention with precise landmarks and boundaries. An accurate technique and a good knowledge of axillaA¢AÂA anatomy are mandatory for a correct and complete ALND. But even with a meticulous and careful technique of dissection, a comprehensive ALND may be associated with important morbidity. Nowadays ALND indications are continuously evolving, but the procedure has still an indisputable place in breast cancer treatment.

Use of a radiotherapy (RT) tumor bed boost in addition to whole breast irradiation (WBI) after oncoplastic breast conserving surgery (OBCS) can be very challenging due to the massive tissue displacements. The aim of our study is to present relevant RT data regarding the use of a boost RT in patients who underwent OBCS and received adjuvant RT at Neolife Medical Center Bucharest.

Breast cancer is particularly recognized as highly unpredictible, even from early stages. Practice has shown the need for personalised treatment in cancer patients. It is mandatory, as it is highly useful, to establish the aggressiveness profile of a malignant breast tumor, in order to plan a targeted treatment.

As a picture speaks more than a thousand words, we tried to reflect, at least in part, on our surgical day-to-day practice on the 2nd Oncological Surgery Department of "Prof. Dr. Al. Trestioreanu" Bucharest Institute of Oncology in the field of breast cancer. And how could we not talk about imaging in breast cancer, when one of the reasons for low breast cancer mortality at present is early detection, which is performed through imaging investigations. Mammographic screening is recognized as a success in this area (Fig. 1), but moreover, mammary ultrasound, a newer addition to this domain, also allows the detection of infraclinical cancers (Fig. 2). The localization of these infraclinical lesions can be obtained preoperatively by mammographic technique using a harpoon (Fig. 3). Under ultrasound guidance we can not only puncture cysts (Fig. 4), but also perform mammary biopsies for suspicious lesions.