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Factors Associated with Axillary Lymph Node Status in Clinically Node-Negative Breast Cancer Patients Undergoing
Chi-Chang Yu1, Yun-Chung Cheung2, Shir-Hwa Ueng3
1Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan.
Cancers
|September 23, 2022
Summary
Neoadjuvant chemotherapy (NAC) can reduce axillary lymph node (ALN) metastasis in breast cancer patients. Achieving a complete response in the breast after NAC indicates negative ALN status, supporting the omission of axillary surgery.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Accurate axillary lymph node (ALN) staging is crucial for invasive breast cancer management.
- Neoadjuvant chemotherapy (NAC) may reduce ALN metastasis risk in clinically node-negative (cN0) patients.
- Understanding factors predicting ALN status post-NAC is essential for treatment planning.
Purpose of the Study:
- To identify factors associated with ALN status in cN0 breast cancer patients receiving NAC.
- To evaluate the impact of achieving breast pathologic complete response (breast-pCR) on ALN metastasis.
- To inform surgical decision-making regarding axillary staging after NAC.
Main Methods:
- Retrospective review of 222 cN0 breast cancer patients undergoing NAC (January 2012 - December 2021).
- Univariate and multivariate analyses to identify predictors of positive ALN status.
- Comparison of surgical procedures based on ALN metastasis and breast-pCR status.
Main Results:
- 17 patients (7.7%) had ALN metastases.
- 90 patients (40.5%) achieved breast-pCR, all with negative ALN status.
- Lymphovascular invasion was an independent predictor of ALN metastasis (OR: 29.366, p < 0.0001).
- Mastectomies were more frequent in patients with ALN metastasis among those without breast-pCR (52.9% vs. 20.9%, p = 0.013).
Conclusions:
- Achieving breast-pCR after NAC is strongly associated with negative ALN status.
- Omission of axillary surgery may be feasible for patients achieving breast-pCR.
- Further prospective studies are needed to validate a two-stage surgical approach for breast-conserving surgery in select patients.
