Identifying Residual Nodal Disease After Neoadjuvant Therapy for Breast Cancer: Focus on Clipped Axillary Node

By: Joshua D. Madera, MD
Posted: Friday, March 29, 2024

For patients with clinically node-positive breast cancer, precise axillary staging after neoadjuvant chemotherapy may be beneficial in identifying residual nodal disease, according to a plenary session presented at the 2024 Society of Surgical Oncology (SSO) Annual Meeting (Abstract 6). These findings emphasize the need for selective excision to effectively guide adjuvant treatment decisions in this patient population, according to Alexandra Moore, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues.

From 2013 to 2023, a total of 680 patients with cN1 breast cancer were recruited for the study. Most were treated with neoadjuvant chemotherapy and targeted axillary dissection. Disease status was confirmed with nodal ultrasound and needle biopsy in all patients. Study participants were characterized according to tumor and treatment factors and were stratified based on their clipped node status as follows: clipped sentinel lymph node (n = 610) or nonsentinel lymph node (n = 70).

Of the 70 clipped nodes that were not characterized as sentinel lymph nodes, 60% were positive for evidence of metastasis. In 52% of these cases, this clipped node was the sole positive node identified. In addition, no significant differences in demographic, clinical, or pathologic characteristics were identified between patients. However, patients with the nonsentinel lymph node as the clipped node tended to have fewer sentinel lymph nodes excised and more than three suspicious nodes detected on ultrasound. Furthermore, multivariate analyses revealed a significantly positive association between the nonsentinel lymph node as well as tumor size at diagnosis and the presence of more than three nodes detected on ultrasound.

Disclosure: Dr. Moore reported no conflicts of interest. For full disclosures of the other study authors, visit sso2024.eventscribe.net.

2024 SSO Annual Meeting