Omission of Axillary Surgery After Neoadjuvant Therapy in Her2-Positive Breast Cancer: Who Are the Candidates?

Simple Summary: The omission of axillary surgery is gaining popularity in selected groups of breast cancer patients. On the other hand, the exceptional nodal responses to neoadjuvant chemotherapy and dual Her2 blockage in Her2-positive breast cancer patients opens the way to the question of whether we can omit axillary surgery in such a group of patients or at least in a certain subgroup. This study aimed to evaluate the lymph node pathological status after neoadjuvant therapy in Her2+ breast cancer patients and to highlight the variables that can predict a pathological complete nodal response so that it can be expected without the need for surgical axillary staging Background: This study aimed to evaluate the lymph node (LN) response in Her2-positive breast cancer patients who received neoadjuvant therapy (NAT) and to discuss if axillary staging can be omitted in these patients. Methods: This is a retrospective cohort study including patients with Her2+ breast cancer at our center from March 2022 to September 2023. Results: The study included 139 patients in the final analysis; 69.1% of the patients had HR+/Her2+ disease while 30.9% had HR−/Her2+ disease. Most of the included patients (129 patients = 92.8%) had initially node-positive or suspicious disease. A total of 112 patients (80.6%) showed clinically negative axillary LNs (cN0) after NAT. All of them showed pathologically node-negative disease. When comparing the pathological node-positive vs. -negative groups, the following was found to be statistically significant: degree of Her2 positivity, number of anti-Her2 cycles, pre- and post-neoadjuvant LN status, and primary tumor radiological and pathological response. Also, all T1 tumors before NAT showed negative LNs after NAT, but it was statistically non-significant. Conclusions: Axillary staging may be omitted in Her2+ patients with cN0 after NAT, especially those with early tumors, strong Her2+ disease, cN0 before NAT, and those in whom the primary tumor achieved a complete clinical response. [ABSTRACT FROM AUTHOR]