# Patient Summary — Axillary Surgery After Pre-Operative Chemotherapy in Node-Positive Breast Cancer

*Plain-language summary (~400 words · 3-minute read)*

**Date**: May 2026
**Authors**: Cervera S, Duque D et al.
**For**: international breast cancer patient organisations (e.g., NBCC, Living Beyond Breast Cancer, Breast Cancer Now, Susan G. Komen)

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## What is "neoadjuvant" treatment?

Neoadjuvant treatment is medical therapy — chemotherapy, targeted drugs (such as anti-HER2 antibodies), or immunotherapy — given **before** surgery. The goal is to shrink the tumour in the breast and to clear any cancer cells that may have spread to the lymph nodes under your arm (the *axilla*).

## Why does it matter whether the lymph nodes "turn negative"?

Before neoadjuvant therapy became standard, women with cancer in the lymph nodes usually had a **full axillary lymph node dissection** — surgical removal of many lymph nodes. This protects against recurrence, but causes **lymphoedema** (chronic arm swelling), numbness, pain, and shoulder stiffness in 15–30% of women.

We now know that modern systemic treatments often **clear the cancer from the lymph nodes**. If a less extensive surgery can confirm the lymph nodes are now cancer-free, the full dissection — and many of its long-term side effects — can be avoided.

## What did this study find?

We reviewed **23 published systematic reviews** that together summarise hundreds of clinical studies from 2006 to 2026. The main findings:

- **Probability that lymph nodes become cancer-free** depends on tumour subtype:
  - **HER2-positive** tumours: 56–72% (more than half).
  - **Triple-negative** tumours: 38–50% (with chemotherapy alone).
  - **Hormone-receptor-positive / HER2-negative** tumours: 7–22% (less likely).
- A surgical technique called **TAD** (Targeted Axillary Dissection — removing the previously clipped node plus a sentinel node) detects any remaining cancer with a **miss rate below 5%**, compared to 16–20% when only a single sentinel node is removed.
- Among women whose lymph nodes became cancer-free and who avoided the full dissection, the chance of cancer returning in the armpit at 5 years was about **1%** — very low.

## What does this mean for my treatment?

- If you have biopsy-proven cancer in a lymph node, ask your team to **place a small clip or marker** in that node *before* starting chemotherapy. This is essential for accurate surgery later.
- After neoadjuvant therapy, if your response is good, you may be a candidate for **less extensive axillary surgery** (TAD, or sentinel node biopsy with proper technique).
- The decision depends on your **tumour subtype**, response to treatment, and the experience of your surgical team.
- A 2024 trial (NSABP B-51) suggests that some women with cancer-free nodes after chemotherapy **may not need additional regional radiotherapy** — discuss this with your radiation oncologist.

## Honest limitations

- Most studies have follow-up of 3–5 years. We know less about **recurrence beyond 5 years**, especially for hormone-receptor-positive cancers.
- Evidence is sparse for **lobular, inflammatory, and metaplastic** breast cancers.
- The impact of **immunotherapy** (pembrolizumab) is still emerging.
- Many of the underlying reviews are of **moderate or low methodological quality**.

## To learn more

- An informational risk calculator (clinical-use orientation, not diagnostic): **ganglio.cicatra.com**
- Talk to your **breast unit** team and contact local patient organisations.
- International resources: NBCC (US), Living Beyond Breast Cancer, Breast Cancer Now (UK), Susan G. Komen, Europa Donna.

> *This summary does not replace the advice of your medical team. Treatment decisions should be made in consultation with your oncologist, surgeon, and radiation oncologist.*
