Accurate axillary lymph node dissection is feasible after neoadjuvant chemotherapy

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Recent reports suggested decreased axillary lymph node retrieval following neoadjuvant chemotherapy.
• This study retrospectively analyzed axillary lymph node dissections (ALNDs) to investigate this claim.

Purpose of the Study:

• To compare axillary lymph node retrieval rates between patients undergoing ALND after neoadjuvant chemotherapy and those undergoing primary ALND.
• To assess the adequacy of lymph node dissection in the neoadjuvant setting.

Main Methods:

• Retrospective analysis comparing 191 patients who had ALND after neoadjuvant chemotherapy with 192 patients who had primary ALND following a positive sentinel node biopsy.
• Statistical comparison of the mean number of lymph nodes retrieved and the proportion of patients with fewer than 10 or more than 20 lymph nodes retrieved.

Main Results:

• No significant difference in the mean number of lymph nodes retrieved between the neoadjuvant (16.3) and primary surgery (15.8) groups (P = .4).
• Similar rates of retrieving fewer than 10 lymph nodes (7% vs. 6%, P = .7).
• A higher proportion of patients in the neoadjuvant group had over 20 lymph nodes retrieved (22% vs. 13%, P = .03).
• Residual lymph node metastasis was observed in 79% of the neoadjuvant group patients.

Conclusions:

• Axillary lymph node dissection after neoadjuvant chemotherapy is feasible and yields adequate lymph node retrieval.
• Sufficient lymph node removal is essential for precise prognostic information and effective local control in breast cancer management.
• The findings support the continued practice of thorough axillary staging even after neoadjuvant chemotherapy.