新辅助化疗（NAC）后的残留疾病具有预后意义并为辅助治疗提供信息。 NAC 后的靶向腋窝淋巴结清扫 (TAD) 假阴性率较低，有利于准确的腋窝分期。本研究利用 TAD 评估腋窝分期中的夹闭淋巴结状态。回顾性审查确定了 2013 年 7 月至 2023 年 6 月接受 NAC 和 TAD 治疗的 cN1 乳腺癌患者。淋巴结超声和活检定义了 cN1 状态。根据夹闭的淋巴结状态（前哨淋巴结 [SLN] 或非 SLN）比较患者、肿瘤和治疗特征。对与被剪除的淋巴结作为非 SLN 相关的因素进行了多变量分析。总共 680 名患者接受了 TAD，其中 94.6% 接受了双示踪剂标测。三名患者 (0.4%) 未发现 SLN。 610 名患者 (90%) 被夹闭的淋巴结为 SLN，70 名患者 (10.3%) 为非 SLN。当夹闭的淋巴结为非前哨淋巴结时，42 个（60%）转移呈阳性。 42 名患者中有 22 名 (52%) 夹闭的非前哨淋巴结是唯一的阳性淋巴结。夹闭的非 SLN 队列中就诊时可疑淋巴结超过 3 个的比例较高（p = 0.003），切除的 SLN 较少（平均 2.2 比 3.5，p ≤ 0.001），阳性 SLN 较少（p ≤ 0.001）。在多变量分析中，超声检查中超过 3 个可疑淋巴结（比值比 3.0，p = 0.001）和就诊时的肿瘤大小（比值比 0.9，p = 0.02）与被夹闭的淋巴结作为非 SLN 显着相关。如果是非 SLN，一半的时间它是 TAD 上唯一的阳性淋巴结和唯一的残留疾病。考虑到对辅助治疗的影响，建议选择性切除淋巴结以精确识别 NAC 后的残留疾病。© 2024。外科肿瘤学会。

Residual disease after neoadjuvant chemotherapy (NAC) is prognostic and informs adjuvant treatment. Targeted axillary dissection (TAD) following NAC has low false-negative rates, facilitating accurate axillary staging. This study evaluates the clipped node status in axillary staging utilizing TAD.Retrospective review identified cN1 breast cancer patients treated with NAC and TAD from July 2013 to June 2023. Nodal ultrasound and biopsy defined cN1 status. Patient, tumor, and treatment characteristics were compared based on clipped node status (sentinel lymph node [SLN] or non-SLN). Multivariate analysis of factors associated with the clipped node as a non-SLN was performed.A total of 680 patients underwent TAD, 94.6% with dual-tracer mapping. In three patients (0.4%), no SLN was identified. The clipped node was a SLN in 610 patients (90%) and non-SLN in 70 (10.3%). When the clipped node was a non-SLN, 42 (60%) were positive for metastasis. In 22 of 42 patients (52%), the clipped non-SLN was the only positive node. The clipped non-SLN cohort had a higher proportion with >3 suspicious nodes at presentation (p = 0.003), fewer SLNs excised (mean 2.2 vs. 3.5, p ≤ 0.001), and fewer positive SLNs (p ≤ 0.001). On multivariate analysis, > 3 suspicious nodes on ultrasound (odds ratio 3.0, p = 0.001) and tumor size at presentation (odds ratio 0.9, p = 0.02) were significantly associated with the clipped node as a non-SLN.When the clipped node was a non-SLN, half of the time it was the only positive node and only residual disease on TAD. Given implications for adjuvant therapy, selective clipped node excision is recommended for precise identification of residual disease after NAC.© 2024. Society of Surgical Oncology.