Main Session
Sep 28
PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology

2731 - Axillary Surgery in Sentinel Node-Positive Breast Cancer after Neoadjuvant Therapy: A Systematic Review

03:00pm - 04:00pm ET
Poster Hall - Exhibit Hall A
Screen: 9
POSTER

Presenter(s)

Mohamad El-Jammal, MD, BS Headshot
Mohamad El-Jammal, MD, BS - Stanford, Stanford, CA

R. El Annan1, M. El-Jammal2, and Y. Zeidan3; 1American University of Beirut Faculty of Medicine, Beirut, Lebanon, 2Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 3Florida International University, Lynn Cancer Institute, Baptist Health South Florida, Boca Raton, FL

Purpose/Objective(s): The role of completion axillary lymph node dissection (ALND) in patients with residual node-positive (ypN+) breast cancer after neoadjuvant therapy remains under investigation in an era of effective systemic therapy and regional nodal irradiation. This systematic review aimed to evaluate locoregional control and survival outcomes in ypN+ patients managed with or without completion of ALND.

Materials/Methods: We systematically searched PubMed/MEDLINE, Embase, and Cochrane Central databases from 2000 through December 2025 for studies comparing completion ALND versus omission of ALND (sentinel lymph node biopsy and/or targeted axillary dissection only) among patients with biopsy-proven node-positive breast cancer treated with neoadjuvant therapy who had residual nodal disease at surgery. Studies published in English with more than 150 patients were included. Two independent reviewers screened and selected studies.

Results: We identified 445 records; after de-duplication and screening, 20 studies were reviewed qualitatively. Five non-randomized comparative studies, including 4,670 patients, provided direct ypN+ outcome comparisons according to axillary surgery extent. In the context of regional nodal irradiation, axillary recurrence rates were low, ranging from 0.37% to 5.7%. Random-effects risk ratio analysis demonstrated no significant difference in axillary recurrence between no ALND (SLNB/TAD) and completion ALND (pooled RR 1.09, 95% CI 0.47-2.52; p=0.80), with moderate heterogeneity (I²=46%). No significant overall survival or disease-free survival advantage for completion ALND was observed after adjustment for patient and tumor characteristics.

Conclusion: In patients with limited ypN+ disease receiving regional nodal irradiation, omission of completion ALND appears to provide comparable locoregional control to ALND while sparing patients the additional morbidity of extensive axillary surgery. These findings support omission of completion ALND in appropriately selected patients. Randomized trials and long-term results of prospective studies are needed to further guide axillary management of patients with residual nodal burden after neoadjuvant therapy.