Neoadjuvant Chemotherapy And Axillary Lymph Nodes: Factors Affecting Lymph Node Yield In Patients Undergoing Axillary Node Dissection

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Abstract
İntroduction: This study aims to investigate the impact of neoadjuvant chemotherapy (NAC) on the number of lymph nodes dissected during axillary lymph node dissection (ALND) in breast cancer patients, a topic of significant debate among surgeons and pathologists. Material and Methods: We conducted a retrospective analysis of 440 breast cancer patients who underwent surgery between January 1, 2018, and December 31, 2020. Patients were categorized into two groups based on NAC administration. We collected demographic, clinical, and pathological data, focusing on the total and malignant lymph node counts. Results: Among the 440 patients, 124 received NAC, while 316 did not. The mean number of lymph nodes removed was 18.1 in total, with 17.2 in the NAC group and 18.5 in the non-NAC group (P = 0.17). No significant differences were observed in the number of malignant lymph nodes between the two groups (P = 0.73). However, multivariate analysis indicated that NAC significantly influenced the total number of lymph nodes dissected (P = 0.05). Additionally, lymphovascular invasion (LVI) was found to significantly impact the number of malignant lymph nodes. Conclusion: Our findings suggest that NAC is associated with a reduced number of lymph nodes dissected during ALND in breast cancer patients. These results indicate that the standard guideline of removing at least 10 lymph nodes may require reconsideration for patients undergoing NAC. Further studies are needed to clarify the implications of these findings for staging and treatment protocols.

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