The following is a summary of “Prediction of the number of positive axillary lymph nodes according to sentinel lymph node involvement and biological subtypes in patients receiving neoadjuvant chemotherapy,” published in the July 2024 issue of Surgery by Yilmaz et al.

Sentinel lymph node biopsy (SLNB) has become the preferred method for assessing axillary lymph node status in patients with clinically node-negative breast cancer, replacing axillary lymph node dissection (ALND). However, the optimal approach to axillary surgery following neoadjuvant chemotherapy (NAC) remains a topic of debate. 

This study aims to predict the pathological nodal stage based on SLNB results and clinicopathological characteristics in patients who initially presented with clinical N1 positivity and achieved clinical N0 status post-NAC.

Researchers included 150 patients with clinically node-negative breast cancer after NAC in this retrospective analysis. Binary and multivariate logistic regression analyses were used to evaluate the relationships between clinicopathologic parameters and the number of positive lymph nodes in SLNBs and ALNDs.

Of 150 patients, 78 had negative SLNBs, while 72 had positive SLNBs. Among 21 patients with SLNB1+ who underwent ALND, no additional node involvement was found in 80.8% of cases; 5 patients (19.2%) had 1-2 positive lymph nodes, and none had ≥3 involved nodes. In SLNB1+ patients, the rate of negative non-sentinel nodes was 75% in the luminal A/B subgroup, 100% in the HER-2-positive subgroup, and 100% in the triple-negative subgroup. Factors associated with a higher likelihood of no additional positive nodes at ALND included lower T stage (T1-3 vs. T4), fewer than 4 clinical nodes before NAC (<4 vs. ≥4), and a decreased postoperative Ki-67 index (<10% vs. stable/increase). Both univariate and multivariate analyses indicated that being in the triple-negative or HER2-positive subgroup, compared to the luminal A/B subgroup, was predictive of a complete lymph node response.

In conclusion, the number of positive nodes in SLNB, along with tumor-related parameters and treatment response, can help predict the likelihood of no additional positive nodes at ALND. This information can guide surgical decision-making and potentially reduce the need for extensive axillary surgery in certain patient subgroups.

Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02500-5