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Axillary Lymph Node Yield Following Axillary Dissection in Biopsy-Proven Node-Positive Breast Cancer: Neoadjuvant

Zachary Pluim1,2, Roy Huynh1, Steven Paredes1

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|April 2, 2026
PubMed
Summary

Neoadjuvant systemic therapy (NAST) slightly reduces lymph node yield after breast cancer surgery, but yields often remain adequate. Tumour biology, not surgical factors, influences yield post-NAST.

Keywords:
axillary lymph node dissectionbreast cancerlymph node yieldneoadjuvant systemic therapyretrospective studies

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • Neoadjuvant systemic therapy (NAST) alters axillary lymph node morphology.
  • The precise impact of NAST on lymph node yield (LNY) after axillary lymph node dissection (ALND) requires further clarification.

Purpose of the Study:

  • To investigate the effect of NAST on lymph node yield (LNY) in patients undergoing axillary lymph node dissection (ALND) for node-positive breast cancer.
  • To identify factors influencing LNY in patients receiving NAST.

Main Methods:

  • Retrospective cohort study of female patients with biopsy-proven node-positive breast cancer (2010-2022).
  • Comparison of LNY between patients receiving NAST and those undergoing primary surgery (PS).
  • Logistic regression analysis to identify predictors of LNY ≥10 within the NAST group.

Main Results:

  • Lower median LNY in the NAST group (17) compared to the PS group (21) (p<0.001).
  • Fewer NAST patients achieved LNY ≥10 (90.8%) versus PS patients (97.5%) (p<0.001).
  • Lymphovascular invasion (LVI) and HR+/HER2- subtype were associated with LNY, while pathological response was not.

Conclusions:

  • NAST is associated with a statistically significant, though modest, reduction in LNY.
  • Despite lower yields, median LNY often exceeds traditional thresholds, and lymph node ratio is preserved.
  • Tumour biology influences post-NAST LNY, necessitating cautious interpretation of historical numeric thresholds.