{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:30:57Z","timestamp":1791325857524,"version":"4.3.1"},"reference-count":37,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:00:00Z","timestamp":1788566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Axillary lymph node dissection (ALND) remains common in patients presenting with a high baseline axillary nodal burden despite substantial nodal downstaging after neoadjuvant chemotherapy (NAC). This study evaluated whether post-neoadjuvant radiologic axillary response could support selective axillary de-escalation in patients with clinically staged cN2 breast cancer and pathologically confirmed axillary metastasis. Methods: This retrospective single-center cohort included 166 cases treated between October 2020 and August 2024. All had pathologically confirmed axillary metastasis, completed neoadjuvant systemic therapy, underwent post-treatment axillary ultrasound, and received definitive surgery. Radiologic node-negative status (radN0) was defined by restoration of benign nodal morphology. Surgical management and pathological nodal outcomes were evaluated according to radiologic response. Results: Radiologic nodal clearance occurred in 61\/166 cases (36.7%), while axillary pathological complete response [ypN0(i\u2212)] was achieved in 59\/166 (35.5%). ypN0(i\u2212) was observed in 53\/61 radN0 cases (86.9%) versus 6\/105 radN+ cases (5.7%; p &lt; 0.001). Among radN0 cases, 47\/61 (77.0%) underwent limited sentinel lymph node biopsy\/targeted axillary dissection (SLNB\/TAD) without ALND, of whom 43\/47 (91.5%) achieved ypN0(i\u2212). Axillary pCR rates varied by molecular subtype, ranging from 20.5% in HR+\/HER2\u2212 disease to 72.2% in triple-negative disease (p &lt; 0.001). No ipsilateral axillary recurrence occurred in the limited SLNB\/TAD group during a median follow-up of 36 months. Conclusions: Post-neoadjuvant radiologic nodal clearance was strongly associated with pathologically node-negative findings and may support consideration of carefully selected responders with cN2 breast cancer for SLNB\/TAD-based staging. Radiologic response should complement, rather than replace, surgical staging and multidisciplinary decision-making.<\/jats:p>","DOI":"10.3390\/cancers18172874","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:23:37Z","timestamp":1788773017000},"page":"2874","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Radiologic Axillary Response After Neoadjuvant Chemotherapy in cN2 Breast Cancer: Decision Support for Selective Axillary De-Escalation"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4605-7822","authenticated-orcid":false,"given":"Mehmet Ali","family":"Nazl\u0131","sequence":"first","affiliation":[{"name":"Department of Radiology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8273-976X","authenticated-orcid":false,"given":"Emel","family":"Esmerer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"S\u00fcmeyye Yeliz","family":"G\u00fcm\u00fc\u015fta\u015f","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0121-4540","authenticated-orcid":false,"given":"Ebru","family":"\u015een","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"project-administration","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3375-9465","authenticated-orcid":false,"given":"G\u00f6kmen Umut","family":"Erdem","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/00000658-199409000-00015","article-title":"Lymphatic mapping and sentinel lymphadenectomy for breast cancer","volume":"220","author":"Giuliano","year":"1994","journal-title":"Ann. 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Treat."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2874\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:37:01Z","timestamp":1788773821000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2874"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,5]]},"references-count":37,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["cancers18172874"],"URL":"https:\/\/doi.org\/10.3390\/cancers18172874","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,5]]}}}