Axillary Overtreatment in Patients with Breast Cancer After
Neoadjuvant Chemotherapy in the Current Era of Targeted
Axillary Dissection

J 2025

Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection

ZAPLETAL, Ondřej; Jan ZATECKY; Lucie GABRIELOVÁ; Iveta SELINGEROVÁ; Miloš HOLÁNEK et. al.

Basic information

Original name

Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection

Authors

ZAPLETAL, Ondřej (203 Czech Republic, belonging to the institution); Jan ZATECKY (203 Czech Republic); Lucie GABRIELOVÁ (203 Czech Republic, belonging to the institution); Iveta SELINGEROVÁ (203 Czech Republic, belonging to the institution); Miloš HOLÁNEK (203 Czech Republic, belonging to the institution); Petr BURKOŇ (203 Czech Republic, belonging to the institution) and Oldřich COUFAL (203 Czech Republic, belonging to the institution)

Edition

Cancers, BASEL, MDPI, 2025, 2072-6694

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30204 Oncology

Country of publisher

Switzerland

Confidentiality degree

is not subject to a state or trade secret

References:

URL

Impact factor

Impact factor: 4.400 in 2024

Organization unit

Faculty of Medicine

DOI

https://doi.org/10.3390/cancers17020178

UT WoS

001403750300001

EID Scopus

2-s2.0-85215807030

Keywords in English

axillary dissection; targeted axillary dissection; breast cancer; neoadjuvant chemotherapy

Abstract

In the original language

Highlights The study aimed to determine the proportion of breast cancer patients indicated for ALND after NAC who later show ypN0, and to identify the reasons that led to ALND which may represent surgical overtreatment. The most common reasons for potentially unnecessary ALND included: inflammatory carcinoma (n = 13, 29.5%), locally advanced carcinoma (n = 5, 11.4%), occult carcinoma (n = 2, 4.5%), or persistent lymphadenopathy on US examination after NAC, particularly in the tumor phenotypes HER2-positive and TNBC (n = 8, 18.2%).Simple Summary This retrospective analysis defines subgroups of breast cancer patients treated with neoadjuvant chemotherapy who may suffer from surgical overtreatment in the axilla even in the current modern era of targeted axillary dissection. These include patients with inflammatory carcinoma, locally advanced carcinoma, occult carcinoma, or patients with persistent findings of suspicious pathological nodes after NAC according to ultrasound examination, especially in the tumor phenotypes HER2-positive and triple-negative breast cancer. Therefore, our study could serve as the background for multidisciplinary teams discussing the possibility of omitting axillary lymph node dissection in a well-selected subgroup of patients with breast cancer after neoadjuvant chemotherapy.Abstract Background: In the current era of targeted axillary dissection (TAD), there are still cases where axillary lymph node dissection (ALND) is indicated, but histopathological examination confirms the regression of nodal metastases (ypN0). In this situation, ALND may represent undesirable overtreatment. Methods: A retrospective study at the Comprehensive Cancer Centre was conducted based on a prospectively maintained database. Patients who underwent surgery after neoadjuvant chemotherapy (NAC) between 2020 and 2023 were selected, specifically those for whom ALND was directly indicated after NAC. Subsequently, clinical-pathological characteristics were compared between cases with ypN0 and those with persistent metastases (ypN+). The reasons for indicating ALND in ypN0 cases were extracted from the medical records. Results: ALND was indicated in 118 cases across 117 patients, of which ypN0 was observed in 44 cases (37%). There were significantly more ypN0 cases for inflammatory carcinomas (68%), the non-luminal HER2-positive phenotype (76%), and carcinomas with histopathological regression of the primary tumor (76%) or the persistence of only the non-invasive component of ypTis (67%). Typical reasons for ALND in ypN0 cases included inflammatory carcinoma (n = 13, 29.5%), locally advanced carcinoma (n = 5, 11.4%), occult carcinoma (n = 2, 4.5%), or persistent lymphadenopathy on ultrasound examination after NAC, especially in the tumor phenotypes HER2-positive and triple-negative breast cancer (TNBC) (n = 8, 18.2%). Conclusions: Through real-world evidence data analysis, subgroups of breast cancer patients treated with NAC were identified who may experience surgical overtreatment in the axilla. These include patients with inflammatory carcinoma, locally advanced carcinoma, occult carcinoma, or patients with persistent lymphadenopathy on US examination after NAC, particularly in the tumor phenotypes HER2-positive and TNBC.

Cite

ZAPLETAL, Ondřej; Jan ZATECKY; Lucie GABRIELOVÁ; Iveta SELINGEROVÁ; Miloš HOLÁNEK; Petr BURKOŇ and Oldřich COUFAL. Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection. Cancers. BASEL: MDPI, 2025, vol. 17, No 2, p. 1-11. ISSN 2072-6694. Available from: https://doi.org/10.3390/cancers17020178.

@article{2474640,
   author = {Zapletal, Ondřej and Zatecky, Jan and Gabrielová, Lucie and Selingerová, Iveta and Holánek, Miloš and Burkoň, Petr and Coufal, Oldřich},
   article_location = {BASEL},
   article_number = {2},
   doi = {https://doi.org/10.3390/cancers17020178},
   keywords = {axillary dissection; targeted axillary dissection; breast cancer; neoadjuvant chemotherapy},
   language = {eng},
   issn = {2072-6694},
   journal = {Cancers},
   title = {Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection},
   url = {https://www.mdpi.com/2072-6694/17/2/178},
   volume = {17},
   year = {2025}
}

TY  - JOUR
ID  - 2474640
AU  - Zapletal, Ondřej - Zatecky, Jan - Gabrielová, Lucie - Selingerová, Iveta - Holánek, Miloš - Burkoň, Petr - Coufal, Oldřich
PY  - 2025
TI  - Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection
JF  - Cancers
VL  - 17
IS  - 2
SP  - 1-11
EP  - 1-11
PB  - MDPI
SN  - 20726694
KW  - axillary dissection
KW  - targeted axillary dissection
KW  - breast cancer
KW  - neoadjuvant chemotherapy
UR  - https://www.mdpi.com/2072-6694/17/2/178
N2  - Highlights The study aimed to determine the proportion of breast cancer patients indicated for ALND after NAC who later show ypN0, and to identify the reasons that led to ALND which may represent surgical overtreatment. The most common reasons for potentially unnecessary ALND included: inflammatory carcinoma (n = 13, 29.5%), locally advanced carcinoma (n = 5, 11.4%), occult carcinoma (n = 2, 4.5%), or persistent lymphadenopathy on US examination after NAC, particularly in the tumor phenotypes HER2-positive and TNBC (n = 8, 18.2%).Simple Summary This retrospective analysis defines subgroups of breast cancer patients treated with neoadjuvant chemotherapy who may suffer from surgical overtreatment in the axilla even in the current modern era of targeted axillary dissection. These include patients with inflammatory carcinoma, locally advanced carcinoma, occult carcinoma, or patients with persistent findings of suspicious pathological nodes after NAC according to ultrasound examination, especially in the tumor phenotypes HER2-positive and triple-negative breast cancer. Therefore, our study could serve as the background for multidisciplinary teams discussing the possibility of omitting axillary lymph node dissection in a well-selected subgroup of patients with breast cancer after neoadjuvant chemotherapy.Abstract Background: In the current era of targeted axillary dissection (TAD), there are still cases where axillary lymph node dissection (ALND) is indicated, but histopathological examination confirms the regression of nodal metastases (ypN0). In this situation, ALND may represent undesirable overtreatment. Methods: A retrospective study at the Comprehensive Cancer Centre was conducted based on a prospectively maintained database. Patients who underwent surgery after neoadjuvant chemotherapy (NAC) between 2020 and 2023 were selected, specifically those for whom ALND was directly indicated after NAC. Subsequently, clinical-pathological characteristics were compared between cases with ypN0 and those with persistent metastases (ypN+). The reasons for indicating ALND in ypN0 cases were extracted from the medical records. Results: ALND was indicated in 118 cases across 117 patients, of which ypN0 was observed in 44 cases (37%). There were significantly more ypN0 cases for inflammatory carcinomas (68%), the non-luminal HER2-positive phenotype (76%), and carcinomas with histopathological regression of the primary tumor (76%) or the persistence of only the non-invasive component of ypTis (67%). Typical reasons for ALND in ypN0 cases included inflammatory carcinoma (n = 13, 29.5%), locally advanced carcinoma (n = 5, 11.4%), occult carcinoma (n = 2, 4.5%), or persistent lymphadenopathy on ultrasound examination after NAC, especially in the tumor phenotypes HER2-positive and triple-negative breast cancer (TNBC) (n = 8, 18.2%). Conclusions: Through real-world evidence data analysis, subgroups of breast cancer patients treated with NAC were identified who may experience surgical overtreatment in the axilla. These include patients with inflammatory carcinoma, locally advanced carcinoma, occult carcinoma, or patients with persistent lymphadenopathy on US examination after NAC, particularly in the tumor phenotypes HER2-positive and TNBC.
ER  -

ZAPLETAL, Ondřej; Jan ZATECKY; Lucie GABRIELOVÁ; Iveta SELINGEROVÁ; Miloš HOLÁNEK; Petr BURKOŇ and Oldřich COUFAL. Axillary Overtreatment in Patients with Breast Cancer After Neoadjuvant Chemotherapy in the Current Era of Targeted Axillary Dissection. \textit{Cancers}. BASEL: MDPI, 2025, vol.~17, No~2, p.~1-11. ISSN~2072-6694. Available from: https://doi.org/10.3390/cancers17020178.

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