对于接受新辅助化疗 (NAC) 的临床淋巴结阳性 (cN ) 乳腺癌患者，在前哨淋巴结活检 [即靶向腋窝清扫术 (TAD)] 期间取回先前切除的、活检证实的阳性淋巴结可能会降低假阴性率。然而，夹闭阳性淋巴结的总体利用率和影响仍不确定。我们回顾性分析了 NAC 后接受腋窝手术的 cN ISPY-2 患者（2011-2022）。我们评估了淋巴结清扫的趋势以及与腋窝手术类型[仅前哨淋巴结 (SLN)、SLN 和腋窝淋巴结清扫术 (ALND) 或仅 ALND] 的关联以及接受 cN 治疗的患者的无事件生存期 (EFS)一项 NAC 试验。在 801 名 cN 患者中，161 名 (20.1%) 在阳性淋巴结中进行了 NAC 前夹子放置。 2011 年至 2021 年间，接受夹子放置的 cN 患者比例从 2.4% 增加至 36.2%。多变量逻辑回归显示，淋巴结夹闭与仅 SLN 手术的较高几率独立相关 [比值比 (OR) 4.3，95% 置信区间(CI) 2.8-6.8，p < 0.001]。对于残留病理学淋巴结阳性（pN）疾病的患者也是如此。 ALND 的完成率不会因剪辑检索成功而有所不同。在有或没有放置夹子、有或没有成功取出夹子的患者中，EFS 没有观察到显着差异 [风险比 (HR) 0.85，95% CI 0.4-1.7，p = 0.7； HR 1.8，95% CI 0.5-6.0，p = 0.3，分别]。在 NAC 之前将夹子放置在阳性淋巴结中越来越常见。即使在 pN 疾病患者中，夹子放置与省略腋窝清扫之间也存在显着关联，这表明 TAD 范式转变为 NAC 后 pN 疾病患者的明确手术治疗策略。© 2024。作者。

For patients with clinically node-positive (cN+) breast cancer undergoing neoadjuvant chemotherapy (NAC), retrieving previously clipped, biopsy-proven positive lymph nodes during sentinel lymph node biopsy [i.e., targeted axillary dissection (TAD)] may reduce false negative rates. However, the overall utilization and impact of clipping positive nodes remains uncertain.We retrospectively analyzed cN+ ISPY-2 patients (2011-2022) undergoing axillary surgery after NAC. We evaluated trends in node clipping and associations with type of axillary surgery [sentinel lymph node (SLN) only, SLN and axillary lymph node dissection (ALND), or ALND only] and event-free survival (EFS) in patients that were cN+ on a NAC trial.Among 801 cN+ patients, 161 (20.1%) had pre-NAC clip placement in the positive node. The proportion of patients that were cN+ undergoing clip placement increased from 2.4 to 36.2% between 2011 and 2021. Multivariable logistic regression showed nodal clipping was independently associated with higher odds of SLN-only surgery [odds ratio (OR) 4.3, 95% confidence interval (CI) 2.8-6.8, p < 0.001]. This was also true among patients with residual pathologically node-positive (pN+) disease. Completion ALND rate did not differ based on clip retrieval success. No significant differences in EFS were observed in those with or without clip placement, both with or without successful clip retrieval [hazard ratio (HR) 0.85, 95% CI 0.4-1.7, p = 0.7; HR 1.8, 95% CI 0.5-6.0, p = 0.3, respectively].Clip placement in the positive lymph node before NAC is increasingly common. The significant association between clip placement and omission of axillary dissection, even among patients with pN+ disease, suggests a paradigm shift toward TAD as a definitive surgical management strategy in patients with pN+ disease after NAC.© 2024. The Author(s).