Dr. Barrio discusses how the use of neoadjuvant chemotherapy (NAC) can help de-escalate axillary node dissection in select patients with breast cancer. Dissection can be a morbid procedure with longterm risks of lymphoma, impacting the quality of life for many patients. To use NAC to de-escalate surgical care in patients, Barrio says physicians must use the approach safely. Dissection can be de-escalated in those patients who have an excellent response to chemotherapy, such as those with HER2-positive or triple-negative disease. Those patients have had the best responses, and Barrio adds she has seen reductions in these patient populations.