AB198. SOH25_AB_282. Does axillary disease burden at diagnosis impact on the probability of axillary complete pathological response post neoadjuvant chemotherapy?
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AB198. SOH25_AB_282. Does axillary disease burden at diagnosis impact on the probability of axillary complete pathological response post neoadjuvant chemotherapy?

Kieran O’Driscoll, Alexandra Zaborowski, Denis Evoy, Jane Rothwell, Claire Rutherford, Michael Boland, Ruth Prichard, Damian McCartan

Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland

Background: Advances in systemic therapy, especially in human epidermal growth factor receptor 2 (HER2) positive and triple negative breast cancer, have enabled de-escalation of axillary surgery following neoadjuvant chemotherapy (NACT) for patients with node positive disease at diagnosis. It is not clear if the burden of axillary nodal involvement at diagnosis should factor into the decision to de-escalate axillary surgery to sentinel node biopsy. This study sought to assess the relationship between axillary nodal burden at diagnosis and axillary pathologic complete response (pCR) following axillary surgery post NACT in patients with HER2 positive and triple negative breast cancer.

Methods: A consecutive series of patients with cytologically proven node-positive breast cancer of the HER2 positive and triple negative breast cancer subtypes, who received NACT and proceeded to therapeutic axillary surgery [sentinel lymph node biopsy (SLNB) or axillary lymph node dissection] between 2016–2021 were retrospectively analysed.

Results: A total of 75 patients (median age 52 years) with HER2 positive (n=34) or triple negative (n=41) breast cancer were included. Forty-three percent had a single abnormal node on imaging at diagnosis and 57% had multiple abnormal nodes. Twenty-five patients (37%) attained an axillary pCR. The rate of axillary pCR did not statistically differ between patients with a single abnormal node on imaging (47%) and those with multiple abnormal nodes (30%) (Chi-squared, P=0.15).

Conclusions: These findings suggest that axillary disease burden at diagnosis does not impact the likelihood of attaining an axillary pCR. Tumour biology and imaging response to neoadjuvant systemic therapy are factors more suited to the selection of patients with node-positive disease at diagnosis for the de-escalation of axillary surgery.

Keywords: Axillary disease; breast cancer; human epidermal growth factor receptor 2 (HER2); pathologic complete response (pCR); triple negative

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab198
Cite this abstract as: O’Driscoll K, Zaborowski A, Evoy D, Rothwell J, Rutherford C, Boland M, Prichard R, McCartan D. AB198. SOH25_AB_282. Does axillary disease burden at diagnosis impact on the probability of axillary complete pathological response post neoadjuvant chemotherapy? Mesentery Peritoneum 2025;9:AB198.

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