# Axillary Pathological Complete Response After Neoadjuvant Therapy in cN1-2 Breast Cancer: An Internally Validated PET/CT-Integrated Nomogram.

**Autores:** Berke&#x15f;o&#x11f;lu M, Arslan G, Tuncel F et al.
**Revista:** Curr Oncol (2025)
**PMID:** 41440195 | **PMCID:** PMC12732181
**DOI:** [10.3390/curroncol32120667](https://doi.org/10.3390/curroncol32120667)
**Fuente:** PubMed Central (open access)

## Relevancia
Aporta evidencia sobre la respuesta axilar y la factibilidad de cirugía axilar conservadora en cáncer de mama inflamatorio tratado con NAC, contexto clásicamente excluido de los estudios de SLNB.

## Abstract
We aimed to develop and internally validate a nomogram to estimate axillary pathological complete response (pCR, ypN0) after neoadjuvant systemic therapy (NAST) in clinically node-positive (cN1-2) breast cancer. In a single-center retrospective cohort of 144 consecutive patients treated with NAST (anti-HER2 as indicated), all underwent standardized pre- and post-NAST 18F-FDG PET/CT and axillary staging (sentinel lymph node biopsy [SLNB], targeted axillary dissection [TAD], or axillary lymph node dissection [ALND]). Axillary pCR occurred in 51.4% (74/144). In a multivariable analysis, independent positive determinants of ypN0 included the triple-negative subtype, Modified PERCIST (SUVmax-based) reduction &#x2265; 80.70%, pre-NAST tumor-to-axilla SUVmax ratio &#x2265; 1.21, and residual breast tumor size < 0.5 mm; conversely, conglomerate/matted nodal morphology at diagnosis was inversely associated. The model showed good internal discrimination (AUC 0.857, 95% CI 0.797-0.917) and acceptable calibration (Hosmer-Lemeshow= 0.425). Exploratory, subtype-restricted signals were observed for inflammatory indices within Luminal B (HER2+) but were not retained in the final model. The resulting nomogram-combining tumor biology, PET/CT response, and pre-NAST nodal features-may support risk stratification for axillary de-escalation after NAST; however, prospective external validation-ideally embedded in ongoing de-escalation frameworks-remains essential before clinical implementation, and the tool should currently be regarded as hypothesis-generating rather than a stand-alone decision aid for routine practice.

## Acceso
Disponible en PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC12732181/

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*Datos de PubMed. Citar: doi 10.3390/curroncol32120667*
