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Related Experiment Video

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Optimizing Axillary Management in Triple-Negative Breast Cancer Following Neoadjuvant Chemotherapy.

Samir Mitri1, Laura Martin Manfroi1, Prabh R Pannu1

  • 1Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, MA.

Clinical Breast Cancer
|April 27, 2025
PubMed
Summary

Many triple-negative breast cancer patients receiving neoadjuvant chemotherapy (NACT) achieve nodal complete response but still undergo axillary lymph node dissection (ALND). Refined criteria are needed to increase axillary de-escalation adoption.

Keywords:
AxillaNeoadjuvant Chemotherapy, Breast cancer surgery, Triple-Negative Breast Cancer, Axillary management

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • Triple-negative breast cancer (TNBC) frequently responds well to neoadjuvant chemotherapy (NACT).
  • This response presents an opportunity for de-escalating axillary surgical treatment.
  • Investigating axillary de-escalation in TNBC is crucial.

Purpose of the Study:

  • To investigate axillary de-escalation strategies in TNBC patients.
  • To identify factors influencing the use of axillary de-escalation.
  • To analyze nodal response rates after NACT in TNBC.

Main Methods:

  • Retrospective analysis of 12,742 TNBC patients (cT1-cT2, cN1) from the National Cancer Database (2012-2020).
  • Analysis of nodal response rates, including pathologic complete response (ypN0).
  • Logistic regression to identify factors associated with axillary management.

Main Results:

  • 31.7% of patients undergoing axillary lymph node dissection (ALND) achieved nodal pathologic complete response (pCR).
  • Nodal pCR was associated with higher rates of breast tumor pCR.
  • Treatment at multiple facilities correlated with increased axillary de-escalation attempts, and ALND rates declined over time.

Conclusions:

  • A significant proportion of TNBC patients with nodal pCR post-NACT still underwent ALND.
  • Current axillary de-escalation criteria may need refinement.
  • Increased adoption of axillary de-escalation strategies is warranted for TNBC management.