Decreased axillary lymph node retrieval in patients after neoadjuvant chemotherapy

Background: The purpose of this study was to assess our clinical impression that fewer lymph nodes are retrieved after level I and II axillary dissection after neoadjuvant chemotherapy and whether there is a positive correlation between the total number of lymph nodes retrieved and the number of diseased lymph nodes. Methods: Patients included those with stage IIB, IIIA, and IIIB breast cancer of whom 77 had neoadjuvant chemotherapy and 58 had initial surgery only. All had modified radical mastectomy with in continuity level I and II axillary dissection. Results: Patients after neoadjuvant chemotherapy had 14.3 ± 6.7 lymph nodes detected versus 16.9 ± 8.8 (mean ± SD; P <0.057) for those with initial surgery only. The number of positive nodes were 3.7 ± 4.7 versus 6.6 ± 8.7 (mean ± SD; P <0.033) respectively and the number of negative nodes were 10.6 ± 7.5 versus 10.4 ± 8 (mean ± SD; P <0.9). The correlation between the number of positive lymph nodes and the total number of lymph nodes was r = 0.58; P <0.001. Conclusions: It appears that fewer lymph nodes are retrieved after level I and II axillary dissection after neoadjuvant chemotherapy. The total number of lymph nodes retrieved increases directly with the number of positive lymph nodes in patients not treated with chemotherapy.