Use of perioperative anti-HER2 therapy presents an opportunity to use a therapy which has been shown to be effective in the adjuvant setting early in the course of a patient’s primary treatment, to assess tumour response in vivo using biomarkers and to potentially improve outcome by suppressing the growth stimulus to cancer cells that is thought to occur due to surgery. Biomarkers measured both before and after a short period of preoperative therapy may offer important predictive and prognostic information that can guide future therapy and follow-up. However, the safety and value of perioperative therapy in this context has not been established and its investigation should therefore be conducted within the context of a randomised, controlled trial. Such a trial, EPHOS-B, will shortly commence in UK alongside POETIC, a parallel trial of perioperative therapy in hormone receptor positive postmenopausal breast cancer.

The most important predictor of outcome for women with early stage breast cancer is the presence or absence of metastases in the axillary lymph nodes. In the era of sentinel lymph node biopsies and improved pathology techniques, micrometastatic disease can be diagnosed. The question of whether or not to treat these women as if they have nodal disease remains in doubt. In order to further explore this topic, we identified two cases of women with nodal micrometastases at our institution. A literature review of PUBMED and SABCS abstracts was then performed. In this article, we discuss our results and the emerging clinical debate about the management of nodal micrometastases.