Barrio AV, Montagna G, Mamtani A, et al. - Axillary lymph node dissection (ALND) can be omitted in patients with clinically node-positive (cN1) breast cancer who achieve nodal pathologic complete response with neoadjuvant chemotherapy (NAC) and receive treatment with sentinel lymph node biopsy (SLNB) alone.

• This study involved a cohort of consecutively identified patients with cT1 to cT3 biopsy-proven N1 breast cancer rendered cN0 by NAC.

• Patients had SLNB with dual tracer mapping and omission of ALND if 3 or more SLNs were detected and all were pathologically negative.

• There were 610 patients with cN1 breast cancer who received treatment with NAC (median [IQR] age, 49 [40-58] years), 555 of these (91%) were converted to cN0 and underwent SLNB.

• Three or more negative SLNs were noted in 234 (42%) patients and SLNB alone was conducted in these; there were low rates of axillary failure at a median follow-up of 40 months, without routine nodal clipping.