Pathological complete response in the axillary lymph nodes post neo-adjuvant chemotherapy in breast cancer, is it predictable?

Ghassan Elamin, Dimple Sapre, Wajiha Tehniyat, Ali Jahan, Mahmoud Dakka


Background: With the recent advances in breast cancer management in the neo-adjuvant chemotherapy (NACT) setting the rates of pathological complete response (pCR) in the breast and the axilla has become more achievable. This has imposed a more conservative surgical approach. While, axillary node clearance (ANC) is still the gold standard procedure in node positive axilla. Converting a node positive into node negative axilla allows surgical de-escalation. However, an evidence-based selection criteria would improve outcomes in this group of patients.
Methods: To formulate a selection criteria for node positive breast cancer patients who would achieve pCR in the axilla post NACT. A retrospective single centre study investigated 103 breast cancer patients with metastatic axillary LNs who underwent NACT between 2009–2017. Initial imaging, post-surgical imaging and histopathology (HP) were compared to the axillary response. Analysis performed using R. Citation: R Core Team [2018].
Results: There has been a statistically significant association between pCR in the axilla and the human epidermal growth factor receptor 2 (HER2) positive cancers (P=0.012), negative lympho-vascular invasion (LVI) (P<0.001), and PCR in the primary breast tumour (P<0.001).
Conclusions: An evidence-based selection criteria to predict pCR in the axilla post NACT in node positive breast cancer patients is possible. This potentially can maximize the benefit of NACT in deescalating the surgical management of the axilla. Prospective studies with larger sample size are needed.