title: Impact of neoadjuvant chemotherapy on axillary nodal involvement in patients with clinically node negative triple negative breast cancer.
abstract: BACKGROUND
  We evaluated the impact of Neoadjuvant Chemotherapy (NAC) versus primary surgery (PS) on axillary disease burden/surgery in clinically node negative Triple Negative Breast Cancer (TNBC).
  
  
  METHODS
  Two hundred forty-three Stage I-III TNBC patients have enrolled on an IRB approved multisite prospective registry. Clinical and treatment information was collected.
  
  
  RESULTS
  One hundred fifty-five patients with clinically node negative TNBC were identified. 47%, 49%, and 4% of patients had T1, T2, and T3 disease, respectively. Patients underwent PS (103/155, 66%) or NAC (52/155, 34%) at the discretion of treating physicians. 17% of PS and 0% of NAC patients were node positive at surgery (P=0.006). For T2 disease, 32% of PS and 0% of NAC patients were node positive at surgery (P=0.001). NAC patients had a lower chance of positive SLNB (0% vs. 12%, P=0.004) and undergoing ALND (2% vs. 22%, P=0.001) than PS patients.
  
  
  CONCLUSIONS
  In this clinically node negative TNBC cohort, all NAC-treated patients were node negative at surgery, whereas 17% of PS patients had involved axillary nodes. NAC should be considered for clinically node negative TNBC to reduce the extent of axillary surgery even if breast conservation is not planned.
authors.affiliation: Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Carol S
authors.initials: CS
authors.lastname: Connor
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Kimler
authors.forename: Joshua M V
authors.initials: JM
authors.lastname: Mammen
authors.forename: Marilee K
authors.initials: MK
authors.lastname: McGinness
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Wagner
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Alsop
authors.forename: Claire
authors.initials: C
authors.lastname: Ward
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Fabian
authors.forename: Qamar J
authors.initials: QJ
authors.lastname: Khan
authors.forename: Priyanka
authors.initials: P
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012042:Registries; D021701:Sentinel Lymph Node Biopsy; D064726:Triple Negative Breast Neoplasms / Q000473:pathology* / Q000628:therapy*
keywords: axillary lymph node dissection; clinically axillary lymph node negative; neoadjuvant chemotherapy; triple negative breast cancer