title: Towards rational axillary treatment in relation to neoadjuvant therapy in breast cancer.
abstract: OBJECTIVE
  The purpose of this study is to analyse nodal staging and axillary response in breast cancer patients treated with neoadjuvant chemotherapy (NAC) to explore venues to safely spare patients axillary clearance whenever it could be avoided.
  
  
  METHODS
  In 327 patients we determined the nodal status before NAC by ultrasound-guided cytology and if indicated by sentinel node biopsy (SNB). In patients with proven metastasis we analysed the axillary response after NAC.
  
  
  RESULTS
  Before NAC, the ultrasound-guided cytology was positive in 252 patients. In the remaining 75 patients SNB was performed prior to NAC. The SNB was negative in 53 patients, thus in these patients axillary clearance could be avoided. All 274 patients with proven axillary metastases at diagnosis underwent axillary clearance after NAC. Twenty percent of the cytology-positive patients (50/252) had an axillary pathological complete remission (pCR) and 68% of the SNB-positive patients (15/22) had no lymph node (LN) metastasis after NAC. Subgroups with a high axillary pCR rate were patients with triple-negative tumours (57%) and human epidermal growth-factor receptor 2 (HER2)-positive tumours (68%) who had a pCR of the primary tumour.
  
  
  CONCLUSIONS
  Twenty percent of the patients with proven metastasis by cytology prior to NAC have an axillary pCR. The axillary pCR rate is very high in certain subgroups. Identification of these patients, could result in more axilla-conserving therapies.
authors.affiliation: Department of Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands. m.straver@nki.nl
authors.forename: M E
authors.initials: ME
authors.lastname: Straver
authors.forename: E J Th
authors.initials: EJ
authors.lastname: Rutgers
authors.forename: N S
authors.initials: NS
authors.lastname: Russell
authors.forename: H S A
authors.initials: HS
authors.lastname: Oldenburg
authors.forename: S
authors.initials: S
authors.lastname: Rodenhuis
authors.forename: J
authors.initials: J
authors.lastname: Wesseling
authors.forename: A
authors.initials: A
authors.lastname: Vincent
authors.forename: M T F D Vrancken
authors.initials: MT
authors.lastname: Peeters
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D018084:Ultrasonography, Interventional