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William J. Gradishar, MD, FACP, FASCO


Axillary Dissection of Residual Tumor Cells After Neoadjuvant Chemotherapy

By: Justine Landin, PhD
Posted: Friday, January 26, 2024

Routine axillary lymph node dissection after neoadjuvant chemotherapy may not be beneficial for patients with breast cancer and micrometastases and macrometastases in the sentinel lymph node, according to Giacomo Montagna, MD, MPH, of Memorial Sloan Kettering Cancer Center, New York, and colleagues. In fact, axillary lymph node dissection appeared to have no significant impact on the risk of recurrence in these patients. The findings of this multicenter, international study were presented at the 2023 San Antonio Breast Cancer Symposium (SABCS; Abstract GS02-02).

“The likelihood of finding additional positive lymph nodes in patients with isolated tumor cells after neoadjuvant chemotherapy is lower than in patients with residual micro- and macrometastases. Overall, these results do not support routine axillary lymph node biopsy in patients with residual isolated tumor cells,” stated the study investigators.

Patients with breast cancer and residual isolated tumor cells after neoadjuvant chemotherapy and either sentinel lymph node biopsy or targeted axillary dissection were included (n = 412). Axillary treatment included completion of axillary lymph node dissection and/or nodal radiotherapy. The cumulative incidence rates of any axillary, locoregional, and invasive recurrence in patients who underwent axillary dissection and in those who did not were identified and compared using Gray’s test.

Axillary lymph node dissection was performed in 146 patients (35.4%) and not performed in 266 patients (64.6%), respectively. Patients treated with axillary lymph node dissection were nearly 10 times more likely to have isolated tumor cells detected (61% vs 6.7%, P < .001). Additional positive nodes were found in 29.5% of cases after axillary lymph node dissection, consisting of macrometastases (7.5%), micrometastases (6.2%), and isolated tumor cells (15.8%). No differences were observed between patients who underwent axillary lymph node dissection and those who did not across 5-year axillary (2.2% and 3.1%, P = .6), locoregional (2.6% and 3.0%, P = .4), or invasive (14% and 18%, P = .12) recurrence, respectively.

Disclosure: Dr. Montagna reported no conflicts of interest. For full disclosures of the other study authors, visit

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