WTP5.11 For patients presenting with T1-2cN1 breast cancer undergoing primary surgery, is Axillary Node Clearance mandatory?

Introduction In our Trust, patients presenting with lymph node metastases who undergo primary surgery (not NACT) will have axillary node clearance (ANC) regardless of the disease burden on initial ultrasound scan. Given that ANC is no longer considered mandatory for many patients identified as having lymph node metastases at sentinel node biopsy (SLNB), this is likely to represent over-treatment for a proportion of patients. This audit aimed to assess whether patients were potentially over-treated with ANC and could SLNB be considered as the first surgical treatment for this patient group. Methods Patients presenting between January 2019 and August 2024 who met the following criteria were identified from a prospectively maintained pathology database.Post menopausalG1-2, T1-2, ER+ve, Her2-ve primary breast cancer≤2 abnormal nodes on USS axillaUndergoing primary breast conserving surgery and ANC without neoadjuvant treatment Data were collated using Microsoft Excel. Results Of 421 patients who had ANC over the study period, 31 patients met the inclusion criteria. 21 (67.7%) of patients had ≤2 positive nodes on ANC. Of the remaining patients, 3 (9.7%) had 3-4 positive nodes and 7 (22.5%) had ≥7 positive nodes. Conclusion Approximately two thirds of patients underwent ANC which in hindsight could be deemed unnecessary. Some of these are likely to have avoided ANC if they had undergone SLNB as their first treatment. One third, however, have higher nodal burden than suggested by USS. Further studies are required to establish strategies to safely reduce the numbers of patients being over-treated with ANC.