AB039. SOH25_AB_371. De-escalation of axillary surgery in patients with node positive breast cancer: what criteria should we use?
Clinical Breast

AB039. SOH25_AB_371. De-escalation of axillary surgery in patients with node positive breast cancer: what criteria should we use?

Wala Eljack, Ali Basha, Edel Quinn, Mark Corrigan, Kristali Ylli

Department of Breast Surgery, Cork University Hospital, Wilton, Cork, Ireland

Background: Axillary lymph node dissection (ALND) has long been the standard of care for patients with initially node positive (cN+) breast cancer following neoadjuvant chemotherapy (NACT). However, many patients achieve axillary pathological complete response. Those patients, if identified, can spared significant morbidity from axillary dissection through sentinel lymph node biopsy (SLNB) and/or targeted axillary dissection (TAD). The aim of this study is to assess potential selection criteria for those patients.

Methods: A retrospective observational review of cN+ breast cancer patients treated with NACT followed by axillary surgery, who achieved axillary complete response (ypN0) in a single tertiary referral specialist centre between 2018 to 2023 was performed. Data collected comprised patient characteristics, tumour characteristics, radiological imaging pre- and post NACT and final pathology.

Results: Out of 152 patients who underwent ALND post NACT for cN+ breast cancer in this timeframe, 66 (43%) had ypN0 final histology of which 22 (33.3%) had triple negative breast cancer and 33 (50%) had HER2 positive breast cancer. Out of this 66, 35 (53%) had less than three suspicious lymph nodes at initial assessment. Twenty-three of ypN0 patients had scan assessment post NACT; all had complete or partial radiological response. Seven patients who underwent TAD/SLNB required subsequent axillary clearance for ypN+ disease.

Conclusions: TAD/SLNB for patient with initially cN1 disease with good radiological response to NACT is increasingly performed internationally. Applying these criteria to our patient cohort could reduce the number of patients requiring axillary dissection post NACT, with subsequent reduction in axillary surgery complications including lymphoedema.

Keywords: Axillary clearance; breast cancer; neoadjuvant chemotherapy (NACT); sentinel node biopsy; targeted axillary dissection (TAD)

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-ab039
Cite this abstract as: Eljack W, Basha A, Quinn E, Corrigan M, Ylli K. AB039. SOH25_AB_371. De-escalation of axillary surgery in patients with node positive breast cancer: what criteria should we use? Mesentery Peritoneum 2025;9:AB039.

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