Additional Axillary Disease After Neoadjuvant Chemotherapy for Patients with Clinically Node-Negative but Sentinel...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Axillary lymph node dissection (ALND) carries significant risks of arm morbidity.
• Identifying patients who can safely avoid ALND after neoadjuvant chemotherapy (NACT) is crucial.

Purpose of the Study:

• To identify risk factors for additional axillary disease in clinically node-negative (cN0) breast cancer patients with sentinel lymph node (SLN) metastasis post-NACT.
• To guide the omission of ALND in select patient groups.

Main Methods:

• Retrospective national cohort study of Danish patients (October 2016 - November 2022).
• Analysis included cT1-3, cN0 breast cancer patients with positive SLN biopsy after NACT.
• Univariable and multivariable logistic regression identified predictors of additional axillary disease.

Main Results:

• 346 patients were analyzed; 32% had additional axillary disease at ALND.
• Isolated tumor cells in SLNs correlated with only 11% additional disease.
• Metastasis size (isolated tumor cells, micro-, macrometastases), positive SLN ratio, extracapsular extension, multifocality, and T-stage predicted additional disease.

Conclusions:

• Patients with isolated tumor cells in SLNs post-NACT have a low risk of further axillary disease.
• Metastatic deposit size, number of positive SLNs, and tumor characteristics influence ALND necessity.
• An individualized approach considering these factors is recommended for ALND omission.