AB035. SOH25_AB_242. The rate of non-sentinel lymph node metastases at axillary dissection in patients with a positive sentinel lymph node after neoadjuvant chemotherapy
Clinical Breast

AB035. SOH25_AB_242. The rate of non-sentinel lymph node metastases at axillary dissection in patients with a positive sentinel lymph node after neoadjuvant chemotherapy

Alexandra Zaborowski1, Fabian Wehrmann1, Cathal O’Reilly1, Tim Harding2, Ishwarya Balasubramanian3, Dhafir Alazawi3, Terence Boyle3, Elizabeth Connolly3, Chloe Spillane4, Colm Power4, Michael Allen4, Abeeda Butt4, Arnold Hill4, Lily Nolan5, Aoife Lowery5, Michael Kerin5, Wala Eljack6, Edel Quinn6, Mark Corrigan6, Anna Heeney2, Karl Sweeney2, Mitchel Barry2, Malcolm Kell2, Siun Walsh2, Claire Rutherford1, Denis Evoy1, Jane Rothwell1, Michael Boland1, Damian McCartan1, Ruth Prichard1

1Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland; 2Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland; 3Department of Breast Surgery, St James’s Hospital, Dublin, Ireland; 4Department of Breast Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland; 5Department of Breast Surgery, Galway University Hospital, Galway, Ireland; 6Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland

Background: In patients with a positive sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC), axillary lymph node dissection (ALND) remains the standard of care. The aim of this study was to determine the rate of non-sentinel lymph node (SLN) metastases in patients undergoing completion ALND and to identify factors predictive of positive non-SLNs.

Methods: A retrospective multicentre study was performed. Patients with node positive breast cancer who had a positive SLNB following NAC between 2016–2023 were included. Logistic regression analysis was used to identify factors predictive of positive non-SLNs.

Results: A total of 106 patients were included. The median age was 48 (range 29–74) years. The median number of SLNs removed was 3 (range 1–6) and the median number of positive SLNs was 2 (range 1–4). Additional positive lymph nodes at completion ALND were found in 40% (42/106). Fifty-three percent of patients with micrometastases and 37% with macrometastases had more than 1 additional positive nodes. Final node (N stage) was ypN1 in 73%, ypN2 in 20% and ypN3 in 7%. Multivariable analysis showed that extra-nodal extension [odds ratio (OR) 4.96, 95% confidence interval (CI): 1.96–12.55, P=0.001] and grade 3 disease (OR 3.81, 95% CI: 1.49–9.69, P=0.005) were associated with a higher likelihood of positive non-sentinel nodes. The presence of macrometastases or ypT3 tumours were not significantly associated with further positive nodes.

Conclusions: In patients with a positive SLNB after NAC, 40% will have additional positive nodes. Grade and extranodal extension are predictive of additional nodal burden.

Keywords: Axilla; breast cancer; chemotherapy; neoadjuvant; sentinel node

Acknowledgments

None.

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-ab035
Cite this abstract as: Zaborowski A, Wehrmann F, O’Reilly C, Harding T, Balasubramanian I, Alazawi D, Boyle T, Connolly E, Spillane C, Power C, Allen M, Butt A, Hill A, Nolan L, Lowery A, Kerin M, Eljack W, Quinn E, Corrigan M, Heeney A, Sweeney K, Barry M, Kell M, Walsh S, Rutherford C, Evoy D, Rothwell J, Boland M, McCartan D, Prichard R. AB035. SOH25_AB_242. The rate of non-sentinel lymph node metastases at axillary dissection in patients with a positive sentinel lymph node after neoadjuvant chemotherapy. Mesentery Peritoneum 2025;9:AB035.

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