Objective:

To analyze factors influencing axillary pathological complete response (pCR) in HER2+ breast cancer patients undergoing neoadjuvant chemotherapy (NAC), specifically focusing on age, initial tumor size, tumor grade, Ki-67, and axillary radiologic response, aiming to reduce unnecessary lymphadenectomies.

Key Findings:

• Axillary pCR achieved in up to 74% of HER2+ cases post-NAC, indicating a significant response to treatment.
• Factors predicting axillary pCR include age, initial tumor size, tumor grade, Ki-67, and axillary radiologic response to NAC, which can guide treatment decisions.
• Guidelines suggest targeted axillary dissection for patients with ≤3 suspicious nodes achieving axillary radiologic complete response, potentially reducing unnecessary surgeries.

Interpretation:

The study highlights the potential to avoid axillary lymph node dissection in selected HER2+ breast cancer patients based on predictive factors for axillary pCR.

Limitations:

• Retrospective design may introduce selection bias, limiting the ability to draw definitive conclusions.
• Limited sample size of 60 patients may affect generalizability of the findings to broader populations.

Conclusion:

Identifying predictive factors for axillary pCR can lead to less invasive management strategies in HER2+ breast cancer, ultimately improving patient outcomes and reducing the need for extensive surgical interventions.