Can Axillary Ultrasound Identify Node Positive Patients Who can Avoid an Axillary Dissection After Neoadjuvant...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Axillary lymph node dissection (ALND) is standard for invasive breast cancer with axillary metastasis post-neoadjuvant chemotherapy (NAC) if no complete response (n-pCR) is achieved.
• Predicting residual nodal disease burden is crucial for treatment de-escalation strategies.

Purpose of the Study:

• To evaluate the association between baseline axillary lymph node characteristics and pathological staging after NAC in breast cancer patients without n-pCR.
• To identify patient subgroups who might potentially avoid completion ALND.

Main Methods:

• Retrospective analysis of 55 breast cancer patients with axillary metastasis treated with NAC and subsequent ALND.
• Review of pre-treatment ultrasound findings, clinical exams, and post-chemotherapy surgical pathology (ypN stage).

Main Results:

• 64% of patients had ypN1 disease, 29% ypN2, and 7% ypN3 after NAC.
• Among patients with a single suspicious lymph node on initial ultrasound, 85% had ypN1 disease.
• Patients with one suspicious lymph node and a normal clinical exam post-NAC had a 100% rate of ypN1 disease.

Conclusions:

• A normal clinical axillary exam and a single abnormal lymph node on pre-treatment ultrasound predict ypN1 disease in breast cancer patients without n-pCR after NAC.
• Consideration for omitting completion ALND in this specific patient group is warranted, pending further trial results.