Axillary lymph node count is lower after neoadjuvant chemotherapy.
BACKGROUND
Retrieval of fewer than 10 lymph nodes at axillary dissection (ALND) for breast cancer can represent anatomic variation or inadequate dissection. We postulated that despite aggressive ALND, a lower lymph node count is more frequent after neoadjuvant chemotherapy.


METHODS
Patients who received neoadjuvant chemotherapy followed by ALND were compared with patients who received surgery first. All patients received a level I and II ALND at a single institution by one of the breast surgeons. The number of nodes retrieved at ALND was dichotomized into categories (< 10 and > or = 10), and compared using Fisher exact test.


RESULTS
A total of 143 neoadjuvant and 170 surgery-first patients were studied. Patients treated with neoadjuvant chemotherapy were significantly more likely to have fewer than 10 lymph nodes retrieved at ALND than were the surgery-first patients (19/143 or 13% vs. 6/170 or 4%, P = .003).


CONCLUSIONS
A low lymph node count is more common in patients after treatment with neoadjuvant chemotherapy and should not be assumed to represent an incomplete ALND.
Neuman
Heather
H
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Carey
Lisa A
LA
Ollila
David W
DW
Livasy
Chad
C
Calvo
Benjamin F
BF
Meyer
Anthony A
AA
Kim
Hong Jin
HJ
Meyers
Michael O
MO
Dees
E Claire
EC
Collichio
Fran A
FA
Sartor
Carolyn I
CI
Moore
Dominic T
DT
Sawyer
Lynda R
LR
Frank
Jill
J
Klauber-DeMore
Nancy
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology / Q000517:prevention & control; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000970:Antineoplastic Agents