Axillary Management in Breast Cancer Patients with Positive Lymph Nodes Following Neoadjuvant Chemotherapy

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Patients with biopsy-proven axillary disease require completion axillary lymph node dissection (cALND) if sentinel lymph nodes (SLN) remain positive post-neoadjuvant chemotherapy (NAC).
• Axillary de-escalation strategies aim to reduce morbidity associated with cALND.
• Evaluating predictors of non-SLN involvement is crucial for patient selection in axillary de-escalation.

Purpose of the Study:

• To determine the frequency of involved non-SLN during cALND in node-positive breast cancer patients post-NAC.
• To identify clinical, radiologic, and pathologic predictors of non-SLN involvement.

Main Methods:

• A multicenter, retrospective cohort study included 122 node-positive breast cancer patients with residual nodal metastases (ypN+) post-NAC who underwent cALND after SLN biopsy or targeted axillary lymph node dissection.
• Patients were grouped based on the presence (cALND+) or absence (cALND-) of positive non-SLN.
• Multivariate analysis identified predictors of cALND+.

Main Results:

• Nearly half (46.7%) of the 122 patients had positive non-SLN (cALND+).
• Predictors of cALND+ included: abnormal lymph nodes on pretreatment axillary ultrasound (OR 3.74), SLN extracapsular extension (OR 2.6), lymphovascular invasion (OR 2.47), and a SLN ratio > 0.5 (OR 4.33).

Conclusions:

• This study identifies key factors predicting non-SLN involvement in ypN+ patients post-NAC.
• These predictors can help select patients who may benefit from cALND and those who might be spared the procedure, supporting axillary de-escalation.