title: Axillary lymph node count is lower after neoadjuvant chemotherapy.
abstract: 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.
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Neuman
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Carey
authors.forename: David W
authors.initials: DW
authors.lastname: Ollila
authors.forename: Chad
authors.initials: C
authors.lastname: Livasy
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Calvo
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Meyer
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Michael O
authors.initials: MO
authors.lastname: Meyers
authors.forename: E Claire
authors.initials: EC
authors.lastname: Dees
authors.forename: Fran A
authors.initials: FA
authors.lastname: Collichio
authors.forename: Carolyn I
authors.initials: CI
authors.lastname: Sartor
authors.forename: Dominic T
authors.initials: DT
authors.lastname: Moore
authors.forename: Lynda R
authors.initials: LR
authors.lastname: Sawyer
authors.forename: Jill
authors.initials: J
authors.lastname: Frank
authors.forename: Nancy
authors.initials: N
authors.lastname: Klauber-DeMore
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents