Evaluation of Residual Axillary Lymph Node Metastases After Neoadjuvant Treatment in Breast Cancer

The present study aims to evaluate the volume of residual axillary nodal disease after neoadjuvant chemotherapy (NACT) in breast cancer.

Predictive factors for low-volume residual axillary nodal disease were analyzed in patients with histologically proven breast cancer (cT1-3 cN0-2) who were treated with NACT and surgery between 2015 and 2019.

A total of 734 patients were analyzed. Breast pathological complete response (pCR) was achieved in 35.1%, with 31.5% showing no residual tumor in the breast or axillary lymph nodes (LNs). Breast and axillary pCR rates varied according to receptor subtype, with the highest rates found in HER2+ and hormone receptor (HR) negative tumors. Among 385 patients presenting with axillary metastases at diagnosis, 41.0% achieved axillary pCR, and 38.4% had 1-3 metastatic LNs. Predictive factors for axillary pCR included cN stage, HR status, ycN status, and breast pCR. For breast pCR patients with cN+ at presentation, the rate of axillary pCR was 81.1%. After NACT, 68.7% of patients with >2 metastatic LNs at diagnosis had 0-3 residual LNs.

We conclude that breast pCR, HER2+, HR negative breast cancer, <3 metastatic axillary LNs at diagnosis, and complete axillary imaging response after NACT were associated with axillary pCR rates and low probability of >3 positive LNs. Similarly, our study showed that axillary pCR in patients with more than 2 metastatic LNs was comparable to that of patients with 1-2 metastatic LNs highlighting an opportunity to tailor axillary surgery in this subgroup.