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Is Residual Nodal Disease at Axillary Dissection Associated with Tumor Subtype in Patients with Low Volume Sentinel Node Metastasis After Neoadjuvant Chemotherapy?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In patients with a positive sentinel lymph node (SLN) after neoadjuvant chemotherapy (NAC), the likelihood of residual nodal disease at axillary dissection (ALND) is high. Whether non-SLN metastasis frequency varies based on tumor subtype and SLN metastasis size is uncertain. We examined the association between tumor subtype and frequency of non-SLN metastases in patients with SLN micro- vs macrometastases after NAC.

Methods

Patients with invasive breast cancer and a positive SLN biopsy after NAC between July 2008 and July 2019 were identified. Associations between tumor subtype, SLN disease volume, and frequency of non-SLN metastases were examined.

Results

Among 273 patients with ≥ 1 positive SLN and a completion ALND, mean age was 51 years, 87% of tumors were ductal, 80% were clinically node-positive at presentation, and 85% were cT2-3. The frequency of non-SLN metastases was non-significantly higher in HR+/HER2- (61%) vs. HER2+ (52%) and triple negative tumors (45%) (p = 0.09). Frequency of SLN micrometastasis was 9% for triple negative tumors compared with 17% for HR+/HER2- and 34% for HER2+ tumors (p = 0.015). Size of SLN metastasis (micro- vs. macrometastases) was not associated with non-SLN metastasis frequency or number within any subtype.

Conclusions

In patients with a positive SLN after NAC, the likelihood of non-SLN metastasis at ALND was high across all tumor subtypes and did not vary significantly for SLN micro- versus macrometastases. ALND is recommended for SLN micro- and macrometastases after NAC, irrespective of tumor subtype.

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Acknowledgment

All authors made a substantial contribution to the material submitted for publication, all have read and approved the manuscript, and none have financial incentive associated with publishing the article.

Funding

This study was supported in part by the NIH/NCI Cancer Center Support Grant P30 CA008748 to Memorial Sloan Kettering Cancer Center.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Tracy-Ann Moo MD, Kate R. Pawloski MD, Tiana Le BS, Audree Tadros MD, Andrea V. Barrio MD & Monica Morrow MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jessica Flynn MS

  3. Diagnostic Cytology and Breast Pathology Services, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Marcia Edelweiss MD

Authors
  1. Tracy-Ann Moo MD
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  2. Kate R. Pawloski MD
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  3. Jessica Flynn MS
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  4. Marcia Edelweiss MD
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  5. Tiana Le BS
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  6. Audree Tadros MD
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  7. Andrea V. Barrio MD
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  8. Monica Morrow MD
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Corresponding author

Correspondence to Tracy-Ann Moo MD.

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Dr. Monica Morrow reports honoraria from Genomic Health and Roche. No other disclosures were reported.

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Moo, TA., Pawloski, K.R., Flynn, J. et al. Is Residual Nodal Disease at Axillary Dissection Associated with Tumor Subtype in Patients with Low Volume Sentinel Node Metastasis After Neoadjuvant Chemotherapy?. Ann Surg Oncol 28, 6044–6050 (2021). https://doi.org/10.1245/s10434-021-09910-2

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  • DOI: https://doi.org/10.1245/s10434-021-09910-2

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