Axillary nodal burden and preoperative predictors in biopsy-proven node-positive breast cancer undergoing upfront surgery
In brief
About six in ten biopsy-proven node-positive breast cancers have three or more positive nodes
In a review of 1,671 patients undergoing upfront axillary dissection, 60% harbored extensive nodal disease (at least 3 positive nodes). A higher number of suspicious nodes on pre-operative ultrasound and larger tumor size independently increased this risk, but predictive accuracy was modest, suggesting ALND cannot be uniformly omitted without further validation.
- Journal
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Q1)
- Published
- 17 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Chi Hoon Lee, Kibeom Kim, Dahn Byun, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, et al.
- PMID
- 42762779
- DOI
- 10.1016/j.ejso.2026.112126
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 21 September 2026): Axillary nodal burden in biopsy‑proven node‑positive breast cancer
Abstract
INTRODUCTION: Recent trials support omitting axillary lymph node dissection (ALND) in selected sentinel node-positive patients, but those with preoperative biopsy-proven nodal metastasis remain underrepresented. We characterized axillary nodal burden and its preoperative predictors. MATERIALS AND METHODS: We retrospectively studied patients with cT1-3 breast cancer and biopsy-proven axillary metastasis who underwent upfront ALND between 2008 and 2023 with at least one positive node. Nodal burden was classified as limited (1-2 positive nodes) or extensive (≥3). Multivariable logistic regression identified predictors. RESULTS: Among 1671 patients (median 21 nodes retrieved), 662 (39.6%) had limited and 1009 (60.4%) had extensive nodal burden. Suspicious node count on axillary ultrasound (AUS) was independently associated with extensive burden (two nodes: OR 2.26, 95% CI 1.64-3.12; ≥3 nodes: OR 2.08, 1.67-2.59; both p < 0.001), as was higher clinical T stage (cT2: OR 1.35, p = 0.009; cT3: OR 1.57, p = 0.008). Extensive burden ranged from 41.0% (cT1, one suspicious node) to 75.0% (cT3, two suspicious nodes). The AUS ≥3 and AUS 2 groups did not differ for ≥3 positive nodes but differed for ≥10 positive nodes (24.8% vs. 14.0%). Among 574 patients with a non-palpable axilla, AUS remained associated with extensive burden whereas clinical T stage did not. CONCLUSION: Extensive nodal burden was common yet heterogeneous. AUS suspicious node count and clinical T stage were associated with extensive disease, but discrimination was modest. These findings do not support uniform omission of ALND and require prospective validation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.