Open Access Research article

Neoadjuvant chemotherapy in breast cancer significantly reduces number of yielded lymph nodes by axillary dissection

Thalia Erbes1, Marzenna Orlowska-Volk2, Axel zur Hausen3, Gerta Rücker4, Sebastian Mayer1, Matthias Voigt6, Juliane Farthmann1, Severine Iborra1, Marc Hirschfeld178, Philipp T Meyer5, Gerald Gitsch1 and Elmar Stickeler1*

Author Affiliations

1 Department of Gynaecology and Obstetrics, University Medical Center Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany

2 Institute of Pathology, University Medical Center Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany

3 Department of Pathology Maastricht, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands

4 Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Stefan-Meier-Strasse 26, 79104 Freiburg, Germany

5 Department of Nuclear Medicine, |University Medical Center Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany

6 Plastic and Aesthetical Surgery Freiburg, Bismarckallee17, 79098 Freiburg, Germany

7 German Cancer Consortium (DKTK), Heidelberg, Germany

8 German Cancer Research Center (DKFZ), Heidelberg, Germany

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BMC Cancer 2014, 14:4  doi:10.1186/1471-2407-14-4

Published: 3 January 2014



Neoadjuvant chemotherapy (NC) is an established therapy in breast cancer, able to downstage positive axillary lymph nodes, but might hamper their detectibility. Even if clinical observations suggest lower lymph node yield (LNY) after NC, data are inconclusive and it is unclear whether NC dependent parameters influence detection rates by axillary lymph node dissection (ALND).


We analyzed retrospectively the LNY in 182 patients with ALND after NC and 351 patients with primary ALND. Impact of surgery or pathological examination and specific histomorphological alterations were evaluated. Outcome analyses regarding recurrence rates, disease free (DFS) and overall survival (OS) were performed.


Axillary LNY was significantly lower in the NC in comparison to the primary surgery group (median 13 vs. 16; p < 0.0001). The likelihood of incomplete axillary staging was four times higher in the NC group (14.8% vs. 3.4%, p < 0.0001). Multivariate analyses excluded any influence by surgeon or pathologist. However, the chemotherapy dependent histological feature lymphoid depletion was an independent predictive factor for a lower LNY. Outcome analyses revealed no significant impact of the LNY on local and regional recurrence rates as well as DFS and OS, respectively.


NC significantly reduces the LNY by ALND and has profound effects on the histomorphological appearance of lymph nodes. The current recommendations for a minimum removal of 10 lymph nodes by ALND are clearly compromised by the clinically already established concept of NC. The LNY of less than 10 by ALND after NC might not be indicative for an insufficient axillary staging.

Lymph node yield; Neoadjuvant chemotherapy; Lymphoid depletion; Breast cancer