⚖️ Transparency notice: this article was written with AI assistance and reviewed by the author, a medical oncologist.

When the breast and the axilla don’t agree: discordance after neoadjuvant therapy in TNBC

Type: B (clinical / real-world) · Source: PMID 42624979 · Cancer Biology & Therapy / Society of Surgical Oncology, 2026

What the evidence DOES support

A retrospective study analyzed 651 patients with triple-negative breast cancer (TNBC) who received neoadjuvant chemotherapy (NACT) and subsequent surgery [PMID: 42624979]. The aim was to quantify how often the pathological response in the breast and the axilla do not match, and what factors predict that discordance [PMID: 42624979].

The authors defined four patterns by combining complete pathological response of the breast (BpCR) and of the nodes (NpCR) [PMID: 42624979]. The results:

• Discordance is the rule, not the exception: it occurred in 30.6% (199/651) of patients [PMID: 42624979].
• If there is breast pCR (BpCR): 17.8% still have residual axillary disease [PMID: 42624979]. That is: a “clean” breast does not guarantee a node-free axilla.
• If there is NO breast pCR: 34.8% achieve nodal pCR (NpCR); in those who started as cN0, the NpCR rate reaches 80.9% [PMID: 42624979].
• The consistent factor is initial axillary burden: higher clinical nodal stage (cN) means higher probability of residual axillary disease (all P < 0.05) [PMID: 42624979]. In patients without BpCR, initial cN was the only independent factor associated with NpCR (all P < 0.001) [PMID: 42624979].
• Immunotherapy: associated with less residual axillary disease (OR 0.259; 95% CI 0.080–0.842; P = 0.025) [PMID: 42624979]. But era-stratified analysis could not reliably estimate it in 2014–2019 and was favorable but not significant in 2020–2024 → cautious interpretation [PMID: 42624979].
• HER2-low: marginal association with more residual disease (OR 2.599; 95% CI 1.013–6.668; P = 0.047) — exploratory marker [PMID: 42624979].

What only promises or is investigational

• The study is retrospective, single-center (Tianjin) and does not change current guidelines [PMID: 42624979].
• The association of immunotherapy with less axillary disease is suggestive but not conclusive due to design (not all regimens included anti-PD-L1 and the subgroup is small) [PMID: 42624979].
• The authors frame it as a basis for designing future axillary de-escalation trials, not as a practice recommendation [PMID: 42624979].

For the consultation

— Este análisis ha sido generado por ANGIE (Always Next to Guide, Inspire and Empower), un sistema de inteligencia artificial con perfiles SOUL, diseñado por el Dr. Javier Pumares Pérez.

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