Related Experiment Video
Updated: Jul 4, 2025
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Axillary lymph node dissection in triple-negative or HER2-positive breast cancer patients with clinical N2 achieving
Xuhui Guo1, Jiao Zhang1, Xilong Gong1
1Department of Breast Disease, Henan Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Dongming Road, Zhengzhou, Henan Province, 450008, China.
Aim:
This study aims to identify suitable candidates for axillary sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) among clinical N2 (cN2) triple-negative (TN) or HER2 positive (HER2+）breast cancer patients following neoadjuvant therapy（NAT）.
Background:
Despite the substantial axillary burden in cN2 breast cancer patients, high pathological response rates can be achieved with NAT in TN or HER2+ subtypes, thus enabling potential downstaging of axillary surgery.
Methods:
A retrospective analysis was conducted on data from the CSBrS-012 study, screening 709 patients with initial cN2, either HER2+ or TN subtype, from January 1, 2010 to December 31, 2020. The correlation between axillary pathologic complete response (pCR) (yPN0) and breast pCR was examined.
Results:
Among the 177 cN2 patients who achieved breast pCR through NAT, 138 (78.0 %) also achieved axillary pCR. However, in the 532 initial clinical N2 patients who did not achieve breast pCR, residual axillary lymph node metastasis persisted in 77.4 % (412/532) of cases. The relative risk of residual axillary lymph node metastasis in patients who did not achieve breast pCR was 12.4 (8.1-19.1), compared to those who did achieve breast pCR, P < 0.001.
Conclusion:
For cN2 TN or HER2+ breast cancer patients who achieve breast pCR following NAT, consideration could be given to downstaging and performing an axillary SLNB or TAD.
Insights
For clinical N2 triple-negative (TN) or HER2-positive (HER2+) breast cancer patients achieving breast pathological complete response (pCR) after neoadjuvant therapy (NAT), axillary sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) may be suitable for downstaging.
Area of Science:
- Oncology
- Breast Cancer Research
- Surgical Oncology
Background:
- Neoadjuvant therapy (NAT) in clinical N2 (cN2) triple-negative (TN) or HER2-positive (HER2+) breast cancer can achieve high pathological response rates.
- This response rate offers potential for downstaging axillary surgery in these patients.
Purpose of the Study:
- To identify suitable candidates for axillary sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD).
- Focus on cN2 TN or HER2+ breast cancer patients who have undergone NAT.
Main Methods:
- Retrospective analysis of the CSBrS-012 study data (2010-2020).
- Inclusion of 709 patients with initial cN2, TN or HER2+ subtypes.
- Examination of the correlation between axillary pathological complete response (pCR) (yPN0) and breast pCR.
Main Results:
- Among 177 cN2 patients with breast pCR post-NAT, 138 (78.0%) achieved axillary pCR.
- In 532 cN2 patients without breast pCR, 77.4% had residual axillary lymph node metastasis.
- Patients not achieving breast pCR had a 12.4-fold increased risk of residual axillary metastasis (P < 0.001).
Conclusions:
- Consideration for downstaging axillary surgery (SLNB or TAD) is warranted for cN2 TN or HER2+ breast cancer patients achieving breast pCR after NAT.
- This approach may reduce the extent of axillary surgery in select patients.
