Heterogeneous Responses of Axillary Lymph Node Metastases to Neoadjuvant Chemotherapy are Common and Depend on Breast Cancer Subtype

  • Antonia Glaeser
  • Hans-Peter Sinn
  • Carlos Garcia-Etienne
  • Fabian Riedel
  • Sarah Hug
  • Benedikt Schaefgen
  • Michael Golatta
  • Andre Hennigs
  • Manuel Feisst
  • Christof Sohn
  • Joerg HeilEmail author
Breast Oncology



The objective of this study was to analyze heterogeneous responses of axillary lymph node metastasis to neoadjuvant chemotherapy and to determine to what extent they differ between tumor subtypes (TN, HER2+, HR+/HER2−).


This retrospective, monocenter study included 72 consecutive, histologically node-positive breast cancers (cT1–4 cN1–3 cM0) diagnosed in the period from January 2015 to December 2016, who had received axillary lymph node dissection following neoadjuvant chemotherapy. All individual lymph node specimens were re-evaluated for the presence of tumor cells and chemotherapy effects to assess their response to neoadjuvant chemotherapy on an individual lymph node level according to the Sataloff classification.


Heterogeneous axillary responses to neoadjuvant chemotherapy occurred in 47.2% of the included 72 patients. The partial response rate was significantly higher in HR+/HER2− tumors (74.2%) than in TN (28.6%) and HER2+ tumors (25.0%) (p < 0.001). The presence of at least one negative, completely responding lymph node in the axillary lymph node dissection specimen had a false-negative rate of 48.8% in predicting ypN0. It dropped below 10% if at least four completely responding negative lymph nodes were identified.


Our study shows that axillary heterogeneous response rates differ significantly between tumor subtypes.



No funding was received in support of this work.



Ethical Standard

The study was approved by the ethics committee of the University of Heidelberg (reference number: S-241/2017). All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments.


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Antonia Glaeser
    • 1
  • Hans-Peter Sinn
    • 2
  • Carlos Garcia-Etienne
    • 3
  • Fabian Riedel
    • 1
  • Sarah Hug
    • 1
  • Benedikt Schaefgen
    • 1
  • Michael Golatta
    • 1
  • Andre Hennigs
    • 1
  • Manuel Feisst
    • 4
  • Christof Sohn
    • 1
  • Joerg Heil
    • 1
    Email author
  1. 1.Department of Obstetrics and Gynecology, University Breast UnitUniversity Women’s Hospital HeidelbergHeidelbergGermany
  2. 2.Institute of PathologyUniversity of HeidelbergHeidelbergGermany
  3. 3.Department of Breast SurgeryFondazione IRCCS Policlinico San MatteoPaviaItaly
  4. 4.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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