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Open Access 04-05-2024 | Metastasis | Breast Oncology

Residual Axillary Metastases in Node-Positive Breast Cancer Patients After Neoadjuvant Treatment: A Register-Based Study

Authors: Frederikke Munck, MD, Maj-Britt Jensen, MSc, Ilse Vejborg, MD, Maria K. Gerlach, MD, Maja V. Maraldo, MD, PhD, Niels T. Kroman, MD, DMSc, Tove H. F. Tvedskov, MD, DMSc

Published in: Annals of Surgical Oncology

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Abstract

Background

Lymph node (LN) metastasis after neoadjuvant chemotherapy (NACT) generally warrants axillary lymph node dissection, which opposes guidelines of upfront surgery in many cases. We investigated the risk of having additional metastases in the axilla when the LNs removed by targeted axillary dissection (TAD) harbored metastases after NACT. We aimed to identify subgroups suitable for de-escalated axillary treatment.

Methods

This register-based study used data from the Danish Breast Cancer Cooperative Group database. Data were analyzed with logistic regression models. The primary outcome was the metastatic burden in non-TAD LNs in patients with positive TAD LNs after NACT.

Results

Among 383 patients, < 66.6% positive TAD LNs (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.17–0.62), only isolated tumor cells (ITCs) [OR 0.11, 95% CI < 0.01–0.82], and breast pathological complete response (pCR) [OR 0.07, 95% CI < 0.01–0.56] were associated with a low risk of having more than three positive non-TAD LNs. In 315 patients with fewer than three positive non-TAD LNs, the proportion of positive TAD LNs (OR 0.45, 95% CI 0.27–0.76 for 33.3–66.6% vs. > 66.6%), size of the TAD LN metastasis (OR 0.14, 95% CI 0.04–0.54 for ITC vs. macrometastasis), tumor size at diagnosis (OR 0.30, 95% CI 0.15–0.64 for 20–49 mm vs. ≥ 50 mm) and breast pCR (OR 0.38, 95% CI 0.15–0.96) were associated with residual LN metastases in the axilla.

Conclusions

Breast pCR or ITC only in TAD LNs can, with reasonable certainty, preclude more than three positive non-TAD LNs. Additionally, patients with only ITCs in the TAD LN had a low risk of having any non-TAD LN metastases after NACT. De-escalated axillary treatment may be considered in both subgroups.
Literature
5.
go back to reference Banys-paluchowski M, Gasparri ML, de Boniface J, et al. Surgical management of the axilla in clinically node-positive breast cancer patients converting to clinical node negativity through neoadjuvant chemotherapy: current status, knowledge gaps, and rationale for the EUBREAST-03 AXSANA study. Cancers (Basel). 2021;13(7):1565. https://doi.org/10.3390/cancers13071565.CrossRefPubMed Banys-paluchowski M, Gasparri ML, de Boniface J, et al. Surgical management of the axilla in clinically node-positive breast cancer patients converting to clinical node negativity through neoadjuvant chemotherapy: current status, knowledge gaps, and rationale for the EUBREAST-03 AXSANA study. Cancers (Basel). 2021;13(7):1565. https://​doi.​org/​10.​3390/​cancers13071565.CrossRefPubMed
7.
go back to reference Simons JM, van Nijnatten TJA, van der Pol CC, van Diest PJ, Jager A, van Klaveren D, Kam BLR, Lobbes MBI, de Boer M, Verhoef C, Sars PRA, Heijmans HJ, van Haaren ERM, Vles WJ, Contant CME, Menke-Pluijmers MBE, Smit LHM, Kelder W, Boskamp M, Koppert LB, Ernest J, Marjolein S. Diagnostic accuracy of radioactive iodine seed placement in the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy in node-positive breast cancer. JAMA Surg. 2022;157(11):991–9. https://doi.org/10.1001/jamasurg.2022.3907.CrossRefPubMedPubMedCentral Simons JM, van Nijnatten TJA, van der Pol CC, van Diest PJ, Jager A, van Klaveren D, Kam BLR, Lobbes MBI, de Boer M, Verhoef C, Sars PRA, Heijmans HJ, van Haaren ERM, Vles WJ, Contant CME, Menke-Pluijmers MBE, Smit LHM, Kelder W, Boskamp M, Koppert LB, Ernest J, Marjolein S. Diagnostic accuracy of radioactive iodine seed placement in the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy in node-positive breast cancer. JAMA Surg. 2022;157(11):991–9. https://​doi.​org/​10.​1001/​jamasurg.​2022.​3907.CrossRefPubMedPubMedCentral
17.
go back to reference Danish Breast Cancer Group. Neoadjuverende kemoterapi ved brystkræft mhp. down-sizing og down-staging. DMCG Klin retningslinjer. 2016;1016(1):14. Danish Breast Cancer Group. Neoadjuverende kemoterapi ved brystkræft mhp. down-sizing og down-staging. DMCG Klin retningslinjer. 2016;1016(1):14.
27.
go back to reference Danish Breast Cancer Group. Medicinsk behandling. DMCG Klin Retningslinjer. 2019:1–37. Danish Breast Cancer Group. Medicinsk behandling. DMCG Klin Retningslinjer. 2019:1–37.
Metadata
Title
Residual Axillary Metastases in Node-Positive Breast Cancer Patients After Neoadjuvant Treatment: A Register-Based Study
Authors
Frederikke Munck, MD
Maj-Britt Jensen, MSc
Ilse Vejborg, MD
Maria K. Gerlach, MD
Maja V. Maraldo, MD, PhD
Niels T. Kroman, MD, DMSc
Tove H. F. Tvedskov, MD, DMSc
Publication date
04-05-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15354-1
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