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Related Experiment Video

Updated: Jul 10, 2026

Single-port Non-liposuction Endoscopic Axillary Lymph Node Dissection in Breast Cancer Surgery
11:49

Single-port Non-liposuction Endoscopic Axillary Lymph Node Dissection in Breast Cancer Surgery

Published on: April 3, 2026

Nodal Pathologic Response After Neoadjuvant Systemic Therapy in Clinically Advanced Node-Positive (cN2 and cN3)

Diana M Jaen1, Collin E Dougherty1, Kimberly A Helseth1

  • 1Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, NE, USA.

Annals of Surgical Oncology
|July 8, 2026
PubMed
Summary

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ASO Visual Abstract: Nodal Pathologic Response after Neoadjuvant Systemic Therapy in Clinically Advanced Node-Positive (cN2 and cN3) Breast Cancer.

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Over one-third of patients with advanced breast cancer achieve a complete response in the lymph nodes after neoadjuvant therapy. This finding suggests potential for de-escalating axillary lymph node dissection in select cases.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • Traditionally, clinically advanced node-positive (cN2/3), non-metastatic breast cancer patients undergo axillary lymph node dissection (ALND) post-neoadjuvant systemic therapy (NST).
  • Randomized trials have excluded cN2/3 disease, leaving a gap in understanding optimal axillary management for these patients.
  • Nodal pathologic complete response (ypN0) after NST suggests potential for less invasive surgical approaches.

Purpose of the Study:

  • To determine the rates of nodal pathologic complete response (ypN0) in patients with cN2/3, non-metastatic breast cancer treated with neoadjuvant chemotherapy (NAC).
  • To identify clinicopathologic factors associated with achieving ypN0 and pathologic complete response (pCR).
  • To analyze the impact of ypN0 and pCR on overall survival (OS).
Keywords:
Axillary surgeryBreast cancerNeoadjuvant therapyNodal responsePathologic complete responseSurgical oncology

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Main Methods:

  • Analysis of the National Cancer Database (NCDB) from 2004-2022.
  • Inclusion of female patients with cN2/3, non-metastatic breast cancer receiving NAC followed by surgery.
  • Stratification by pathologic nodal status, comparison of clinicopathologic variables, and multivariable logistic regression to identify factors associated with pCR. Kaplan-Meier methods were used for OS analysis.

Main Results:

  • Out of 20,402 eligible patients, 36.9% achieved ypN0.
  • ypN0 was associated with younger age, higher Ki-67, and higher tumor grade.
  • Higher ypN0 rates were observed in HER2-positive (70%), hormone receptor-negative (62%), and triple-negative tumors (57%), versus 29% in hormone receptor-positive tumors.
  • Overall pCR was 22.6%, yet 60.8% of patients underwent ALND.
  • Higher Ki-67, younger age, and hormone receptor-negative status were independently associated with pCR.
  • Both pCR and ypN0 were significantly associated with improved OS.

Conclusions:

  • Over one-third of patients with cN2/3, non-metastatic breast cancer achieve ypN0 after NST.
  • These findings present an opportunity to refine axillary management strategies for selected patients.
  • The study underscores the potential for de-escalation of axillary surgery in this patient population.