Pretreatment Axillary Ultrasound Nodal Burden Predicts Outcomes in cN1 Breast Cancer

In a retrospective study of 825 patients with biopsy-proven cN1 breast cancer treated with neoadjuvant systemic therapy and surgery, researchers assessed pretreatment axillary ultrasound findings and survival. More than three abnormal nodes and lack of pathologic complete response were among the independent predictors of worse outcomes.

Study included 825 patients with biopsy-proven cN1 breast cancer.
More than three abnormal nodes predicted worse outcomes.
Five-year overall survival was 92%.
Retrospective findings do not establish treatment benefit.

This retrospective study included 825 patients with cT1–4N1M0 breast cancer and biopsy-proven axillary metastasis treated from 2012 to 2018. All underwent axillary ultrasound before neoadjuvant systemic therapy and again before surgery. The investigators evaluated pathologic response and survival using Kaplan-Meier analyses and multivariable Cox models.

Before treatment, 35.9% of patients had more than three abnormal nodes on ultrasound; 64.1% had one to three. The breast-and-node pathologic complete response rate was 22.7%. After a median follow-up of 5.6 years, five-year overall survival was 92%, breast cancer-specific survival 94%, and event-free survival 91%. Pathologic complete response was prognostic across survival outcomes. Older age, triple-negative subtype, cT4 tumors, lack of pathologic complete response, and more than three abnormal nodes independently predicted worse outcomes.

The findings suggest pretreatment ultrasound nodal burden may help refine risk assessment in cN1 disease. The retrospective design establishes prognostic associations, not that ultrasound-based treatment selection improves outcomes; applicability may also depend on the patient population and treatment practices studied.

In practice

For patients with biopsy-proven cN1 breast cancer receiving neoadjuvant systemic therapy and surgery, pretreatment axillary ultrasound showing more than three abnormal nodes was independently associated with worse outcomes, while pathologic complete response was prognostic across survival measures. These findings may inform risk assessment, but they do not show that changing treatment or axillary surgery according to ultrasound nodal burden improves outcomes. The study was retrospective and reflects patients treated from 2012 to 2018.

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Source

Annals of Surgical Oncology: Predictors of Response to Neoadjuvant Systemic Therapy and Survival in Patients with cN1 Breast Cancer ↗

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