新辅助化疗（NAC）后出现病理性淋巴结疾病的乳腺癌患者越来越多地省略腋窝淋巴结清扫术（ALND）。本研究旨在了解外科医生何时以及为何考虑在 NAC 后省略 ALND。对美国乳腺外科医生协会会员进行了调查，并将答复制成表格。为了识别模式，进行了多重对应分析，然后对前者提供的坐标进行聚类分析。卡方分析确定聚类特征是否与 ALND 的遗漏显着相关（P < 0.05）。在成员中，328/2172 名 (15.1%) 完成了调查。大多数 (60.7%) 总是为对 NAC 有反应的 cN1 患者提供前哨淋巴结手术，并且许多 (43.9%) 有时在残留淋巴结疾病的情况下省略 ALND。随着 NAC 后病理性淋巴结疾病体积的增加，受访者很少考虑省略 ALND，并且与 cN0 相比，在就诊时患有 cN1 疾病的患者中省略 ALND 的可能性较小（所有体积中 P < 0.05）。受访者列举了放射治疗（74.1%），并认为进行腋窝放射治疗时 ALND 不会改善局部区域（48.2%）、远处复发或生存（47.6%）结果，作为省略 ALND 的理由。由男性私人执业外科医生组成的受访者组，执业时间≥21年，考虑省略ALND的频率明显更高。外科医生有时会考虑对NAC后患有病理性淋巴结疾病的患者省略ALND，但在cN0患者和体积较小的患者中更有可能这样做淋巴结疾病。尽管缺乏支持这种降级的前瞻性数据，但这些决定很大程度上是基于缺乏肿瘤学益处的看法。© 2024。外科肿瘤学会。

Axillary lymph node dissection (ALND) is increasingly omitted for breast cancer patients with pathologic nodal disease after neoadjuvant chemotherapy (NAC). This study aimed to understand when and why surgeons consider omitting ALND after NAC.The American Society of Breast Surgeons membership was surveyed, and responses were tabulated. To identify patterns, multiple correspondence analyses followed by cluster analysis on coordinates provided by the former were performed. Chi-squared analyses determined whether cluster characteristics were significantly (P < 0.05) associated with omission of ALND.Of members, 328/2172 (15.1%) completed the survey. Most (60.7%) always offer sentinel lymph node surgery to cN1 patients who respond to NAC, and many (43.9%) sometimes omit ALND in the setting of residual nodal disease. Respondents less often consider omitting ALND with increasing volume of pathologic nodal disease after NAC and are less likely to omit ALND among patients with cN1 disease at presentation than cN0 (P < 0.05 across all volumes). Respondents cited radiation administration (74.1%) and belief that ALND would not improve locoregional (48.2%), distant recurrence or survival (47.6%) outcomes when axillary radiation is administered as reasons to omit ALND. The respondent group comprising male private practice surgeons, practicing ≥ 21 years, consider omitting ALND significantly more frequently.Surgeons sometimes consider ALND omission for patients with pathologic nodal disease after NAC but are more likely to do so in cN0 patients and patients with smaller volumes of nodal disease. These decisions are largely based on perceived lack of oncologic benefit despite absence of prospective data supporting this deescalation.© 2024. Society of Surgical Oncology.