Keywords
How to Cite
Abstract
Introduction. This systematic review evaluates the impact of sentinel lymph node biopsy (SLNB) on long-term oncologic outcomes in breast cancer patients with clinically confirmed axillary lymph node involvement who achieved clinical nodal response after neoadjuvant chemotherapy (NACT). The primary objective was to assess whether SLNB, in the setting of clinical nodal response, provides comparable overall survival (OS) and recurrence-free survival (RFS) outcomes relative to standard axillary lymph node dissection (ALND).
Materials and Methods. A comprehensive literature search was conducted in March 2025 using PubMed and Google Scholar databases with the keywords "breast neoplasm", "node-positive," "neoadjuvant chemotherapy," and "long-term survival." Reference lists of included articles were also manually screened. Eligible studies included randomized controlled trials and retrospective cohort studies evaluating long-term OS, RFS, and axillary recurrence rates in patients with biopsy-proven axillary nodal involvement and complete clinical response following NACT, stratified by the type of axillary surgery performed. Study selection and data extraction were performed independently by two reviewers following PRISMA guidelines. Risk of bias was assessed using the Newcastle–Ottawa Scale.
Results. Of 341 records identified, 20 studies were included in the systematic review. Pooled 5-year OS was 93.3 % in the SLNB group versus 80.0 % in the ALND group, and 5-year RFS was 84.7 versus 73.2 %, respectively (p = 0.001). Axillary recurrence rates remained low and did not differ significantly between groups (0.3–0.9 % for SLNB vs. 0.4–0.6 % for ALND).
Conclusion. The extent of axillary surgery did not demonstrate a statistically significant impact on long-term survival outcomes in node-positive breast cancer patients who achieved complete clinical nodal response after NACT. However, high-quality randomized trials with subgroup-specific analyses are needed to confirm these findings.
References
Connors C., Al-Hilli Z. De-escalation of axillary surgery after neoadjuvant therapy. Clin Breast Cancer. 2024; 24(5): 385-91.-DOI: 10.1016/j.clbc.2024.04.009.
Magnoni F., Galimberti V., Corso G., et al. Axillary surgery in breast cancer: An updated historical perspective. Semin Oncol. 2020; 47(6): 341-52.-DOI: 10.1053/j.seminoncol.2020.09.001.
Pilewskie M., Morrow M. Axillary Nodal management following neoadjuvant chemotherapy. JAMA Oncol. 2017; 3(4): 549.-DOI: 10.1001/jamaoncol.2016.4163.
Sanchez A.M., Terribile D., Franco A., et al. Sentinel node biopsy after neoadjuvant chemotherapy for breast cancer: preliminary experience with clinically node negative patients after systemic treatment. J Pers Med. 2021; 11(3): 172.-DOI: 10.3390/jpm11030172.
Caudle A.S., Yang W.T., Krishnamurthy S., et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: Implementation of targeted axillary dissection. J Clin Oncol. 2016; 34(10): 1072-8.-DOI: 10.1200/JCO.2015.64.0094.
Galimberti V., Ribeiro Fontana S. K., Vicini E., et al. This house believes that: Sentinel node biopsy alone is better than TAD after NACT for cN + patients. Breast. 2023; 67: 21-5.-DOI: 10.1016/j.breast.2022.12.010.
Abdulloeva Sh.Sh., Kaprin A.D., Zikiryakhodzhaev A.D., et al. Results of targeted lymphadenectomy in patients with breast cancer cT1-3N1M0 after neoadjuvant systemic therapy. Res Pract Med J. 2025; 12(1): 8-25.-DOI: 10.17709/2410-1893-2025-12-1-1.
Емельянов А., Криворотько П., Жильцова Е., et al. Хирургическое стадирование аксиллярной области у больных раком молочной железы категории сN + перешедших в категорию ycN0 после неоадъювантной терапии. Вопросы онкологии. 2022; 68(3): 322-332.-DOI: 10.37469/0507-3758-2022-68-3-322-332. [Axillary surgery after neoadjuvant chemotherapy in breast cancer patients downstaging from cN + to ycN0. Voprosy Onkologii = Problems in Oncology. 2022; 68(3): 322-332.-DOI: 10.37469/0507-3758-2022-68-3-322-332 (In Rus)].
Caudle A.S., Bedrosian I., Milton D.R., DeSnyder S.M., et al. Use of sentinel lymph node dissection after neoadjuvant chemotherapy in patients with node-positive breast cancer at diagnosis: Practice patterns of American Society of Breast Surgeons Members. Ann Surg Oncol. 2017; 24(10): 2925-34.-DOI: 10.1245/s10434-017-5958-4.
Page M.J., McKenzie J.E., Bossuyt P.M., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; n71.-DOI: 10.1136/bmj.n71.
Covidence systematic review software. The world's #1 systematic review tool.-URL: http://www.covidence.org (22.03.2025).
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9): 603-5.-DOI: 10.1007/s10654-010-9491-z.
Damin A.P., Zancan M., Melo M.P., Biazus J.V. Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with node-positive breast cancer: guiding a more selective axillary approach. Breast Cancer Res Treat. 2021; 186(2): 527-34.-DOI: 10.1007/s10549-020-06011-8.
Tercan I.C., Zengel B., Ozdemir O., et al. The oncologic safety of sentinel lymph node biopsy in patients with node-positive breast cancer with complete response to neoadjuvant chemotherapy: A single-center experience. Breast Journal. 2023.-DOI: 10.1155/2023/4549033.
Lee S.B., Kim H., Kim J., et al. Prognosis according to clinical and pathologic lymph node status in breast cancer patients who underwent sentinel lymph node biopsy alone after neoadjuvant therapy. PLoS One. 2021; 16(5): e0251597.-DOI: 10.1371/journal.pone.0251597.
Limberg J.N., Jones T., Thomas S.M., et al. Omission of axillary lymph node dissection in patients with residual nodal disease after neoadjuvant chemotherapy. Ann Surg Oncol. 2024; DOI: 10.1245/s10434-024-16143-6.
Kim J.Y., Kim M.K., Lee J.E., et al. Sentinel lymph node biopsy alone after neoadjuvant chemotherapy in patients with initial cytology-proven axillary node metastasis. J Breast Cancer. 2015; 18(1): 22.-DOI: 10.4048/jbc.2015.18.1.22.
Kim H., Han J., Kim S.Y., et al. Sentinel lymph node biopsy in breast cancer patients with pathological complete response in the axillary lymph node after neoadjuvant chemotherapy. J Breast Cancer. 2021; 24(6): 531.-DOI: 10.4048/jbc.2021.24.e48.
Kahler-Ribeiro-Fontana S., Pagan E., Magnoni F., et al. Long-term standard sentinel node biopsy after neoadjuvant treatment in breast cancer: a single institution ten-year follow-up. Eur J Surg Oncol. 2021; 47(4): 804-12.-DOI: 10.1016/j.ejso.2020.10.014.
Cabioglu N., Karanlik H., Igci A., et al. Breast cancer recurrence in initially clinically node-positive patients undergoing sentinel lymph node biopsy after neoadjuvant chemotherapy in the NEOSENTITURK-trials MF18-02/18-03. Ann Surg Oncol. 2025; 32(2): 952-66.-DOI: 10.1245/s10434-024-16472-6.
Andrea V., Barrio M., Giacomo Montagna M.M., et al. Nodal recurrence in patients with node-positive breast cancer treated with sentinel node biopsy alone after neoadjuvant chemotherapy—a rare event. JAMA Oncol. 2021; 7(12): 1851-1855.-DOI: 10.1001/jamaoncol.2021.4394.
Montagna G., Mrdutt M.M., Sun S.X., et al. Omission of axillary dissection following nodal downstaging with neoadjuvant chemotherapy. JAMA Oncol. 2024; 10(6): 793-798.-DOI: 10.1001/jamaoncol.2024.0578.
Lim S.Z., Yoo T.K., Lee S.B., et al. Long-term outcome in patients with nodal-positive breast cancer treated with sentinel lymph node biopsy alone after neoadjuvant chemotherapy. Breast Cancer Res Treat. 2024; 203(1): 95-102.-DOI: 10.1007/s10549-023-07104-w.
Gerber B., Schneeweiss A., Möbus V., et al. Pathological response in the breast and axillary lymph nodes after neoadjuvant systemic treatment in patients with initially node-positive breast cancer correlates with disease free survival: An exploratory analysis of the GeparOcto trial. Cancers (Basel). 2022; 14(3): 521.-DOI: 10.3390/cancers1403052.
Pislar N., Gasljevic G., Ratosa I., et al. Absence of post-treatment changes in sentinel lymph nodes does not translate into increased regional recurrence rate in initially node-positive breast cancer patients. Breast Cancer Res Treat. 2023; 202(3): 443-50.-DOI: 10.1007/s10549-023-07084-x.
Wong S.M., Basik M., Florianova L., et al. Oncologic safety of sentinel lymph node biopsy alone after neoadjuvant chemotherapy for breast cancer. Ann Surg Oncol. 2021; 28(5): 2621-9.-DOI: 10.1245/s10434-020-09211-0.
Choi H.J., Kim I., Alsharif E., et al. Use of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with axillary node-positive breast cancer in diagnosis. J Breast Cancer. 2018; 21(4): 433-41.-DOI: 10.4048/jbc.2018.21.e54.
Park Y., Shin Y.S., Kim K., et al. Omission of axillary lymph node dissection in patients with ypN + breast cancer after neoadjuvant chemotherapy: A retrospective multicenter study (KROG 21-06). Eur J Surg Oncol. 2023; 49(3): 589-96.-DOI: 10.1016/j.ejso.2022.11.099.
Chun J.W., Kim J., Chung I.Y., et al. Sentinel node biopsy alone for breast cancer patients with residual nodal disease after neoadjuvant chemotherapy. Sci Rep. 2021; 11(1): 9056.-DOI: 10.1038/s41598-021-88442-x.
Sparger C.C., Hernandez A.E., Rojas K.E., et al. Axillary management and long-term oncologic outcomes in breast cancer patients with clinical N1 disease treated with neoadjuvant chemotherapy. World J Surg Oncol. 2024; 22(1).-DOI: 10.1186/s12957-024-03477-4.
Maimaitiaili A., Fan Z., Zhang J., et al. Prognostic value of pathological nodal burden after neoadjuvant chemotherapy in initially cN0-1 breast cancer patients: a dual-center, 10-year survival analysis. Ther Adv Med Oncol. 2024; 16.-DOI: 10.1177/17588359241248318.
Tinterri C., Barbieri E., Sagona A., et al. De-escalation of axillary surgery in clinically node-positive breast cancer patients treated with neoadjuvant therapy: comparative long-term outcomes of sentinel lymph node biopsy versus axillary lymph node dissection. Cancers (Basel). 2024; 16(18).-DOI: 10.3390/cancers16183168.
Zhang M., Sun Y., Wu H., et al. Prognostic analysis of cT1-3N1M0 breast cancer patients who have responded to neoadjuvant therapy undergoing various axillary surgery and breast surgery based on propensity score matching and competitive risk model. Front Oncol. 2024; 14. DOI: 10.3389/fonc.2024.1319981.
Keelan S., Boland M.R., Ryan É.J., et al. Long-term survival in patients with node-positive breast cancer who undergo sentinel lymph node biopsy alone after neoadjuvant chemotherapy: meta-analysis. Br J Surg. 2023; 110(3): 324-32.-DOI: 10.1093/bjs/znac413.
Ding Y., Wu W., Ni X., Wang Z. Long-term survival of node-positive breast cancer with complete nodal response to neoadjuvant chemotherapy treated with sentinel lymph node biopsy alone: A meta-analysis. Oncology. 2025; 1-23.-DOI: 10.1159/000543662.
Rana M., Weiss A., Laws A., et al. Abstract PS01-02: Long-term outcomes of sentinel lymph node biopsy following neoadjuvant chemotherapy for initially node-positive breast cancer: A systematic review and meta-analysis. Cancer Res. 2024; 84(9_Supplement): PS01-02-PS01-02.-DOI: 10.1158/1538-7445.SABCS23-PS01-02.
Falo C., Azcarate J., Fernandez-Gonzalez S., et al. Breast cancer patient’s outcomes after neoadjuvant chemotherapy and surgery at 5 and 10 years for stage II–III disease. Cancers (Basel). 2024; 16(13): 2421.-DOI: 10.3390/cancers16132421.
Haque W., Verma V., Hatch S., et al. Response rates and pathologic complete response by breast cancer molecular subtype following neoadjuvant chemotherapy. Breast Cancer Res Treat. 2018; 170(3): 559-67.-DOI: 10.1007/s10549-018-4801-3.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2026