Omission of Axillary Lymph Node Dissection in Breast Cancer Patients with Residual Nodal Disease After Neoadjuvant Chemotherapy

Background

The study aimed to evaluate the impact of omitting axillary lymph node dissection (ALND) on oncological outcomes in breast cancer patients with residual nodal disease after neoadjuvant chemotherapy (NAC).

Methods

Medical records of patients who underwent NAC followed by surgical resection and had residual nodal disease were retrospectively reviewed. A total of 1273 patients from 12 institutions were included, all of whom underwent postoperative radiotherapy. Axillary surgery consisted of ALND in 1103 patients (86.6%) and sentinel lymph node biopsy (SLNBx) alone in 170 (13.4%).

Results

The median follow-up was 75.3 months. Axillary recurrence rates were 4.8% in the ALND group and 4.7% in the SLNBx group. Before propensity score matching (PSM), the 5-year overall survival (OS) rate was inferior in the ALND group compared to the SLNBx group (86.6% vs. 93.3%, respectively; P = 0.002). After PSM, there were no significant differences between the ALND and SLNBx groups in disease-free survival (DFS) or OS.

Conclusions

SLNBx alone did not compromise oncological outcomes in patients with residual nodal disease after NAC. The omission of ALND might be a possible option for axillary management in patients treated with NAC and postoperative radiotherapy.

Introduction

Axillary lymph node dissection (ALND) was previously regarded as a standard approach for the diagnosis and eradication of lymph node metastasis in patients with breast cancer. However, due to significant morbidity associated with ALND, axillary management has evolved into less invasive approaches. Sentinel lymph node biopsy (SLNBx) alone has replaced ALND after confirmation of its accuracy and reduced morbidity.

Discussion

The study found that the type of axillary surgery was not associated with prognosis in patients with residual axillary disease after NAC. This suggests that SLNBx alone could be a viable alternative to ALND in certain cases, potentially reducing the morbidity associated with more invasive procedures.