Nodal Response Research Articles

Tislelizumab in combination with gemcitabine plus cisplatin as neoadjuvant therapy for lymph node‐positive bladder cancer: Results of a prospective study.

619 Background: Although multiple single-arm clinical trials have shown promising pathologic complete response (pCR) rates with neoadjuvant ICIs combined with gemcitabine plus cisplatin in MIBC, lymph node‐positive bladder cancer is generally excluded. In this study, our specific aim was to compare the efficacy and prognosis of neoadjuvant tislelizumab combined with gemcitabine plus cisplatin in patients with lymph node‐positive bladder cancer. Methods: In this investigator-initiated study, eligible patients had cT2-T4 N+ M0 MIBC, cisplatin-eligible, and to be planned radical cystectomy (RC). Patients received tislelizumab 200 mg in day 8 (D8), cisplatin 70 mg/m2 D2-4, and gemcitabine 1000 mg/m2 D1 and D8 every 21 days for 3 or 4 cycles. RC was performed within 6 weeks after last dose treatment. The primary endpoint was pathologic complete response (pCR, ypT0). Secondary endpoints included pathologic downstaging (<ypT2), EFS, OS and safety. Results: A total of 15 pts were enrolled,14 pts (2 cT2, 7 cT3, 5 cT4) have completed neoadjuvant therapy and underwent RC. One patient declined surgery for personal reasons and received further systemic therapy. In 14 pts evaluable for efficacy, the investigator-assessed confirmed clinical complete response was 21.4% (3/14). Final pathologic results showed that 5 pts (50%) achieved pCR (ypT0N0), 4 ypT1, and 5 ypT2/T3, and 9 patients (<ypT2N0,64.2%) had staging downgrades, with no patients experiencing progression. A complete nodal response (pN0) occurred in 11 (78.5%) pts after tislelizumab +chemotherapy. The median follow-up was 8.9 months, with one death due to multiple metastases and the remaining patients showing no signs of recurrence or metastasis. Median EFS and OS was not reached. Most common neoadjuvant therapy-related AEs of any grade were hematologic toxicities (11/14,78.5%), nausea (9/14,64.2%), vomiting (8/14,57.1%). Grade ≥3 neoadjuvant therapy-related AEs were neutropenia (n = 3), thrombocytopenia (n = 2), anemia (n = 2). One patient discontinued tislelizumab due to AEs. Conclusions: The combination of tislelizumab and gemcitabine/cisplatin is clinically active with a manageable safety profile as a neoadjuvant therapy for lymph node‐positive bladder cancer. Clinical trial information: NCT04570410 .

Structural damage detection of 3-D truss structure using nodal response analysis

Structural damage detection of 3-D truss structure using nodal response analysis

Bipartite network influence analysis of a two-mode network

A two-mode network contains two types of nodes, and edges exist only between any two nodes that are associated with different entities. Owing to the network connections (i.e., edges) between the two types of network nodes, nodal responses are unlikely to be independently and identically distributed, resulting in possible nodal heterogeneity across the two types of nodes. This study proposes a novel bipartite network influence model (BNIM) to evaluate nodal heterogeneity from the perspective of nodal influence. To make the model estimable, we parameterize the influence indices with a set of nodal attributes through a prespecified link function, and employ the quasi-maximum likelihood approach to estimate the unknown parameters. Score tests are presented to examine the heterogeneity of nodal influences across the two types of nodes. To assess the adequacy of the link function, we carry out a quasi-likelihood ratio test and establish its asymptotic properties under the appropriate conditions. Simulation studies and the real data analysis of a fund-stock network are studied to assess the finite-sample performance of BNIM.

Prolongation of stimulus-A interval with wider QRS complex during para-Hisian pacing maneuver-Is this a nodal response?

Prolongation of stimulus-A interval with wider QRS complex during para-Hisian pacing maneuver-Is this a nodal response?

Absent ventriculo-atrial conduction during right ventricular apical pacing but nodal response during para-Hisian pacing – What is the mechanism?

A 13-year-old-girl presented with one episode of pre-syncope while standing in a train. Her ECG was suggestive of preexcitation. Echocardiography revealed structurally normal heart without any ventricular hypertrophy. During electrophysiology study, her ventriculo-atrial (VA) conduction was absent even on isoprenaline. However, a para-Hisian pacing maneuver (PHP) revealed consistent VA conduction with a nodal response. This finding indicated that the VA dissociation at baseline was at infra-Hisian (VH) level and conduction at HA level was intact. In addition, this finding is coherent with a speculation of a fasciculo-ventricular pathway (FVP) resulting in such an ECG pattern in her. Pacing from various atrial sites (right atrium, coronary sinus) exhibited nearly fixed preexcitation and short non-varying HV interval confirmatory of FVP. Testing for a PRKAG mutation was advised for her.

Therapeutic Nanovaccines Reshape the Metabolic and Immune Microenvironment for Enhancing Immunotherapy of Primary and Lymphatic Metastatic Tumors

AbstractThe effectiveness of anti‐metastasis therapy is hampered by the highly immunosuppressive microenvironment found in both tumor tissues and lymph nodes. In this work, a therapeutic nanovaccine, CaGlu NPs, is introduced composed of calcium carbonate nanoparticles (CaCO3 NPs) and β‐glucan. Through the synergistic effect of CaCO3 NPs and β‐glucan, CaGlu NPs can induce immunogenic cell death in tumor tissues, repolarize tumor macrophages, reverse the immunosuppressive tumor microenvironment, effectively activate antigen‐specific cytotoxic T lymphocytes, promote dendritic cells maturation, and eventually elicit an effective anti‐tumor immune response in both primary tumors and metastatic lymph nodes. Meanwhile, CaGlu NPs can remodel the metabolic microenvironment in tumors and lymph nodes by decreasing the expression of lactate dehydrogenase A and hypoxia‐inducible factor‐1α, further enhancing the anti‐tumor immune response. CaGlu NPs also inhibit tumor angiogenesis and lymphangiogenesis and induce long‐term immune memory effects. This therapeutic nanovaccine strategy, which simultaneously remodels the metabolic and immunosuppressive microenvironments in tumors and metastatic lymph nodes, showed strong anti‐metastatic effects in vivo. This study presents a promising approach to effectively treat lymph node metastatic tumors using nanomaterial‐assisted immunotherapies and underscores its broad potential for clinical applications.

The Role of Ultrasound in Axillary Lymph Node Response to Neoadjuvant Chemotherapy in Breast Cancer Patients

The Role of Ultrasound in Axillary Lymph Node Response to Neoadjuvant Chemotherapy in Breast Cancer Patients

IL-17 receptor A functions to help maintain barrier integrity and limit activation of immunopathogenic response to H. pylori infection.

Activation of Th17 cell responses, including the production of IL-17A and IL-21, contributes to host defense and inflammatory responses by coordinating adaptive and innate immune responses. IL-17A and IL-17F signal through a multimeric receptor, which includes the IL-17 receptor A (IL-17RA) subunit and the IL-17RC subunit. IL-17RA is expressed by many cell types, and data from previous studies suggest that loss of IL-17 receptor is required to limit immunopathology in the Helicobacter pylori model of infection. Here, an Il17ra-/- mouse was generated on the FVB/n background, and the role of IL-17 signaling in the maintenance of barrier responses to H. pylori was investigated. Generating the Il17ra-/- on the FVB/n background allowed for the examination of responses in the paragastric lymph node and will allow for future investigation into carcinogenesis. While uninfected Il17ra-/- mice do not develop spontaneous gastritis following H. pylori infection, Il17ra-/- mice develop severe gastric inflammation accompanied by lymphoid follicle production and exacerbated production of Th17 cytokines. Increased inflammation in the tissue, increased IgA levels in the lumen, and reduced production of Muc5ac in the corpus correlate with increased H. pylori-induced paragastric lymph node activation. These data suggest that the cross talk between immune cells and epithelial cells regulates mucin production, IgA production, and translocation, impacting the integrity of the gastric mucosa and therefore activating of the adaptive immune response.

Ibrutinib As First Line Therapy in Chronic Lymphocytic Leukemia Patients over 80 Years Old: A Retrospective Real-Life Multicenter Italian Cohort

Background: Although CLL primarily affects older adults (median age 71 years), limited data exist about the outcomes of adults who are ≥80 years old because they are under-enrolled in clinical trials. Methods: We performed a multicenter national study enrolling consecutive treatment-naïve CLL patients ≥80 years at the time of frontline CLL therapy, treated with ibrutinib. Kaplan-Meier analyses were used to plot progression-free survival (PFS) and overall survival (OS). Results: Our study included 79 patients with CLL who were aged ≥80 years at the time of frontline CLL therapy starting between 1/2014 and 3/2021; the clinical features of these patients are summarized in Table 1. A total of 13 (16.5%) patients achieved a nodal clinical response (CR; bone marrow evaluation was not performed), 58 (73.4%) a partial response (PR) or PR + lymphocytosis (PR+L), 3 (3.8%) a stable disease (SD), and 5 (6.3%) were not evaluated since they early withdrew ibrutinib. Discontinuation because of progressive disease (PD) occurred in 9 cases (11%), whereas discontinuation due to toxicity in 11 patients (13.9%). The most common grade >3 adverse events (AEs) were infections (25.5%), neutropenia (10.1%), and anemia (2.5%). Eighteen patients (22.8%) experienced cardiovascular events: 9 (11%) had atrial fibrillation (AF), 5 hypertension (6%), 3 heart failure (3%), and 1 acute coronary syndrome (1%). All cases of AF and hypertension were of grade 2. Patients with AF received anticoagulation and no thrombotic stroke were recorded. Bleeding events were observed in 27 (34.2%) patients but were mild, of grade 1-2 in 24 and grade 3 in 3. Patients who received anticoagulants or anti-platelets drugs did not experienced a significantly higher rate of hemorrhagic events than those not assuming anticoagulation. Secondary malignancies were reported in 6 patients (7.8%) and Richter's transformation in five. Temporary drug withdrawal (7-30 days) occurred in 33 patients (41.8%): in 17 (21.5%) due to infections, 5 (6.3%) cardiovascular events, 10 (12.7%) hemorrhagic events, and 4 (5.1%) hematologic toxicity. Ibrutinib was permanently discontinued in 26 patients (32%): in 9 with PD (Richter's syndrome, 5), 6 with secondary malignancies, 5 with infections, 3 with cardiac failure, 2 due to severe bleeding and a sudden death was reported in 1. After a median follow-up of 24 months, the median PFS was 49.3 months (95% CI 39.9-58.7) and the median OS 51.8 (95% CI 50.1-53.5). Age, sex, creatinine clearance, Binet stage, del17p, TP53 and IGHV mutational status did not significantly impact PFS. Conversely, CIRS >6 was associated with a significantly shorter PFS (median PFS: 33.1 months, 95% CI 25.3-40.9 vs. not reached, p=0.016). A significantly longer PFS (p=0.03) was observed in the 46 patients who never discontinued ibrutinib or stopped the drug for less than 7 days (median PFS 66.3 months, 95% CI 50.5-82.1) compared to those with a transient treatment discontinuation, between 7 and 30 days, (median PFS; 32.7 months, 95% CI 23.2-42.3) (Figure 1). Sex, creatinine clearance, Binet stage, IGHV, del17p, and TP53 mutational status, as well as CIRS, did not significantly impact OS. Conversely, a trend toward a statistically significant longer OS (P=0.07) was observed for patients who discontinued ibrutinib <7 days (67.2 months, 95% CI 43.5-90.9) compared with those who discontinued for 7-30 days (51.8 months, 95% CI 34.4-69.2). Conclusions: To our knowledge, this is the largest real-world study examining treatment-naive elderly patients receiving ibrutinib as first-line therapy. Ibrutinib represents a suitable therapeutic choice even for patients aged >80 years with comorbidities. In this setting of patients, the drug was well tolerated and no new side effects were recorded.

Strain/displacement field reconstruction and load identification of bracket arm structure of high-speed maglev train based on superposition conversion algorithm

The bracket arm structure, subjected to long-term vertical levitation and transversal guidance forces, is a key load-bearing component of high-speed maglev trains. It is crucial to monitor strain, displacement, and load in real time to evaluate structural health. However, it is almost impossible to measure directly at the service site of trains due to the intricacy of the bracket arm structure and the constrained installation area. Hence, it is an effective and feasible approach to reconstruct the strain/displacement field using a limited amount of strain information from FBG sensors. In order to reconstruct the strain/displacement field and identify the load on complicated structures, a load–strain/displacement superposition conversion algorithm is proposed in this paper. The modal coordinate and the mode-shape matrix are swapped out for the load weight and the load–strain/displacement matrix, respectively. Thus, it gets around the difficulty of choosing the mode order in traditional modal theory. In addition, the algorithm can achieve full-field reconstruction of both strain and displacement by measuring only part of the nodal strain response, reducing the redundancy of the traditional algorithm. Finally, numerical simulations and experimental tests were carried out to verify the feasibility of the proposed method for field reconstruction and load identification.

ASO Visual Abstract: Deep Learning Radiomics Nomogram Based on Enhanced CT to Predict the Response of Metastatic Lymph Nodes to Neoadjuvant Chemotherapy in Locally Advanced Gastric Cancer.

ASO Visual Abstract: Deep Learning Radiomics Nomogram Based on Enhanced CT to Predict the Response of Metastatic Lymph Nodes to Neoadjuvant Chemotherapy in Locally Advanced Gastric Cancer.

Deep Learning Radiomics Nomogram Based on Enhanced CT to Predict the Response of Metastatic Lymph Nodes to Neoadjuvant Chemotherapy in Locally Advanced Gastric Cancer.

We aimed to construct and validate a deep learning (DL) radiomics nomogram using baseline and restage enhanced computed tomography (CT) images and clinical characteristics to predict the response of metastatic lymph nodes to neoadjuvant chemotherapy (NACT) in locally advanced gastric cancer (LAGC). We prospectively enrolled 112 patients with LAGC who received NACT from January 2021 to August 2022. After applying the inclusion and exclusion criteria, 98 patients were randomized 7:3 to the training cohort (n = 68) and validation cohort (n = 30). We established and compared three radiomics signatures based on three phases of CT images before and after NACT, namely radiomics-baseline, radiomics-delta, and radiomics-restage. Then, we developed a clinical model, DL model, and a nomogram to predict the response of LAGC after NACT. We evaluated the predictive accuracy and clinical validity of each model using the receiver operating characteristic curve and decision curve analysis, respectively. The radiomics-delta signature was the best predictor among the three radiomics signatures. So, we developed and validated a DL delta radiomics nomogram (DLDRN). In the validation cohort, the DLDRN produced an area under the receiver operating curve of 0.94 (95% confidence interval, 0.82-0.96) and demonstrated adequate differentiation of good response to NACT. Furthermore, the DLDRN significantly outperformed the clinical model and DL model (p < 0.001). The clinical utility of the DLDRN was confirmed through decision curve analysis. In patients with LAGC, the DLDRN effectively predicted a therapeutic response in metastatic lymph nodes, which could provide valuable information for individualized treatment.

OA15.03 Evaluation of Pathological Tumor and Nodal Responses Following Neoadjuvant Chemoimmunotherapy in NSCLC Patients

OA15.03 Evaluation of Pathological Tumor and Nodal Responses Following Neoadjuvant Chemoimmunotherapy in NSCLC Patients

Association between pathologic response and survival after neoadjuvant therapy in lung cancer

Neoadjuvant immunotherapy plus chemotherapy improves event-free survival (EFS) and pathologic complete response (0% residual viable tumor (RVT) in primary tumor (PT) and lymph nodes (LNs)), and is approved for treatment of resectable lung cancer. Pathologic response assessment after neoadjuvant therapy is the potential analog to radiographic response for advanced disease. However, %RVT thresholds beyond pathologic complete response and major pathologic response (≤10% RVT) have not been explored. Pathologic response was prospectively assessed in the randomized, phase 3 CheckMate 816 trial (NCT02998528), which evaluated neoadjuvant nivolumab (anti-programmed death protein 1) plus chemotherapy in patients with resectable lung cancer. RVT, regression and necrosis were quantified (0–100%) in PT and LNs using a pan-tumor scoring system and tested for association with EFS in a prespecified exploratory analysis. Regardless of LN involvement, EFS improved with 0% versus >0% RVT-PT (hazard ratio = 0.18). RVT-PT predicted EFS for nivolumab plus chemotherapy (area under the curve = 0.74); 2-year EFS rates were 90%, 60%, 57% and 39% for patients with 0–5%, >5–30%, >30–80% and >80% RVT, respectively. Each 1% RVT associated with a 0.017 hazard ratio increase for EFS. Combining pathologic response from PT and LNs helped differentiate outcomes. When compared with radiographic response and circulating tumor DNA clearance, %RVT best approximated EFS. These findings support pathologic response as an emerging survival surrogate. Further assessment of the full spectrum of %RVT in lung cancer and other tumor types is warranted. ClinicalTrials.gov registration: NCT02998528.

Neoadjuvant Chemotherapy plus Radical Surgery in Locally Advanced Cervical Cancer: Retrospective Single-Center Study.

Several pretreatment variables have been found to correlate with the clinical outcome of patients treated with NACT plus radical hysterectomy, such as FIGO stage, tumor size, and lymph node status. A single-center retrospective observational study to evaluate the use of NACT in LACC, particularly in the lymph-node-positive subpopulation. The study, conducted at the Maternal and Child Department of "Cannizzaro Hospital" in Catania, included patients treated between 2009 and 2019. Multivariate analysis was performed to analyze responses to NACT according to clinicopathologic parameters. Kaplan-Meyer disease-free survival (DFS) and overall survival (OS) curves were generated according to different lymph node status subgroups. A total of 151 consecutive patients were enrolled in the study. Significant independent risk factors for response to NACT were preoperative tumor diameter, parametrium involvement, and lymphoma vascular space invasion (LVSI). T initial diameter at NMR was found to be the independent prognostic predictor for general (p = 0.024) and lymph node (LND) response (p = 0.028). Tumors between 2 and 6 cm have a better response to NACT than tumors > 6 cm, and LVSI absence was an independent prognostic factor for LND response to NACT. Survival DFS and OS curves were significant for positive vs. negative pathologic LND. Neoadjuvant chemotherapy followed by surgery cannot be considered a standard of care in patients with locally advanced cervical cancer, particularly in the subgroup with pre-NACT imaging suspected for LND metastases.

Bladder-draining lymph nodes support germinal center B cell responses during urinary tract infection in mice.

Bacterial urinary tract infections (UTIs) are both common and exhibit high recurrence rates in women. UTI healthcare costs are increasing due to the rise of multidrug-resistant (MDR) bacteria, necessitating alternative approaches for infection control. Here, we directly observed host adaptive immune responses in acute UTI. We employed a mouse model in which wild-type C57BL/6J mice were transurethrally inoculated with a clinically relevant MDR UTI strain of uropathogenic Escherichia coli (UPEC). Firstly, we noted that rag1-/- C57BL/6J mice harbored larger bacterial burdens than wild-type counterparts, consistent with a role for adaptive immunity in UTI control. Consistent with this, UTI triggered in the bladders of wild-type mice early increases of myeloid cells, including CD11chi conventional dendritic cells, suggesting possible involvement of these professional antigen-presenting cells. Importantly, germinal center B cell responses developed by 4 weeks post-infection in bladder-draining lymph nodes of wild-type mice and, although modest in magnitude and transient in nature, could not be boosted with a second UTI. Thus, our data reveal for the first time in a mouse model that UPEC UTI induces local B cell immune responses in bladder-draining lymph nodes, which could potentially serve to control infection.

Long-Term Outcomes and Predictors of Response in Breast Cancer Patients with Advanced Nodal Involvement.

Advanced nodal disease is associated with poor prognosis. However, modern neoadjuvant systemic therapy (NST) regimens have resulted in higher pathologic complete response (pCR) rates, which are associated with improved survival. We sought to assess contemporary outcomes in patients with advanced nodal involvement and response to NST. We conducted a single-institution, retrospective study of 521 patients with cN2-3 primary nonmetastatic breast cancer treated with NST followed by surgery and radiation from 2012 to 2018. Descriptive statistics, multivariate Cox regression, and Kaplan-Meier analyses were performed. The mean age was 50.5 years, and median follow-up was 61 (4.7 to 197) months. The majority of patients had hormone receptor-positive (HR+)/HER2-negative tumors (HER2-; n = 242, 47.8%). Most were cT2 (n = 243; 46.6%) or cT3 (n = 139; 26.7%) and 73.3% (n = 382) had cN3 disease. Rate of axillary pCR was 34.2%, and breast and axillary pCR was 19.4% (n = 101). Event-free survival (EFS) at 5 years was 75.1% (95% CI, 0.71 to 0.79). Rate of locoregional recurrence was 6.7%; distant metastatic rate was 29.4%. Axillary pCR with or without breast pCR was significantly associated with longer EFS (p = 0.001). Achieving breast/axillary pCR was an independent predictor of improved EFS (hazard ratio 0.22, p < 0.0001). Having triple-negative disease was associated with worse EFS (hazard ratio 1.74, p = 0.008). In a high-risk cohort of patients with cN2-3 disease, trimodality therapy was effective in achieving durable EFS. Approximately one-third of patients achieved axillary pCR, which was associated with improved survival. Further studies are needed to accurately determine axillary response in cN2-3 breast cancer after NST in order to develop de-escalation strategies to reduce morbidity associated with axillary surgery.

Activation and induction of antigen-specific T follicular helper cells play a critical role in recombinant SARS-CoV-2 RBD vaccine-induced humoral responses

The role of follicular T helper (Tfh) cells in humoral response has been considered essential in recent years. Understanding how Tfh cells control complex humoral immunity is critical to developing strategies to improve the efficacy of vaccines against SARS-CoV-2 and other emerging pathogens. However, the immunologic mechanism of Tfh cells in SARS-CoV-2 receptor binding domain (RBD) vaccine strategy is limited. In this study, we expressed and purified recombinant SARS-CoV-2 RBD protein in Drosophila S2 cells for the first time and explored the mechanism of Tfh cells induced by RBD vaccine in humoral immune response. We mapped the dynamic of Tfh cell in lymph node and spleen following RBD vaccination and revealed the relationship between Tfh cells and humoral immune response induced by SARS-CoV-2 RBD vaccine through correlation analysis, blocking of IL-21 signaling pathway, and co-culture of Tfh with memory B cells. Recombinant RBD protein elicited a predominant Tfh1 and Tfh1-17 subset response and strong GC responses in spleen and lymph nodes, especially to enhanced vaccination. IL-21 secreted by Tfh cells affected the development and differentiation of B cells and played a key role in the humoral immune response. These observations will help us further understand the mechanism of protective immune response induced by COVID-19 vaccine and has guiding significance for the development of vaccines against newly emerging mutants.

Evaluation of combined pathological responses in primary tumor and lymph nodes following neoadjuvant chemoimmunotherapy in non-small cell lung cancer

BackgroundInconsistent pathological responses of tumor and lymph nodes (LNs) were frequently observed in non-small cell lung cancer (NSCLC) receiving neoadjuvant chemoimmunotherapy. However, there is a lack of studies to report the prognostic significance and the relevant clinicopathological factors of tumor-nodal inconsistent responses after neoadjuvant immunotherapy or chemoimmunotherapy. Therefore, this study aimed to depict the inconsistent pathological combined tumor-nodal responses in NSCLC patients after neoadjuvant chemoimmunotherapy as well as the underlying clinical significance. MethodsA total of 81 node-positive NSCLC patients who underwent neoadjuvant chemoimmunotherapy were eligible for inclusion. Demographic, radiologic, and pathological features of patients were recorded. Patients with pathological complete response of both tumor (ypT(pCR)) and LNs (ypN0) were classified into the combined good responder group and the relevant clinicopathological features were evaluated. The event-free survival (EFS) outcome was analyzed using Kaplan-Meier analysis. ResultsThe ypN0 and ypT(pCR) rates were 74.1 % and 42.0 %, respectively. A significant correlation was observed between ypT(pCR) and ypN0 (P = 0.003), but inconsistent responses remained. The combined responses of the primary tumor and LNs demonstrated a significant association with the prognosis outcome (P = 0.005). Notably,patients who received at least twice of their infusions of immune checkpoint inhibitors after 15:30 had a worse prognosis (P = 0.015). ConclusionA significant but not absolute correlation was observed between good tumor response and good nodal response in NSCLC patients after neoadjuvant chemoimmunotherapy, but inconsistent responses were also found. The combination of tumor and nodal responses is significantly associated with prognosis and combined good responder can be used as a reliable prognosis predictor.

Can Axillary Ultrasound Identify Node Positive Patients Who can Avoid an Axillary Dissection After Neoadjuvant Chemotherapy?

IntroductionAxillary lymph node dissection (ALND) is recommended for patients with invasive breast cancer with axillary metastasis treated with neoadjuvant chemotherapy (NAC) who do not have a nodal pathologic complete response (n-pCR). We hypothesized that patients with a single, ultrasound-suspicious, nonpalpable lymph node (LN) at diagnosis, who do not achieve an n-pCR, will have ypN1 disease on surgical pathology. MethodsThis retrospective study identified breast cancer patients in our institution from 2012 to 2020 with axillary metastasis treated with NAC who did not achieve an n-pCR and had an ALND. Patient's tumor characteristics, axillary ultrasound, and lymph node disease burden at the time of surgery were reviewed. ResultsFifty five patients met the criteria and 36% had one suspicious LN on ultrasound, 25% had 2, and 38% had >3. After chemotherapy, 64% had ypN1 disease, 29% had ypN2 disease, and 7% had ypN3 disease. Of the 20 patients with one abnormal LN on initial ultrasound, 17 (85%, 95% CI 61-96%) had ypN1 disease. Eleven patients with one abnormal LN on initial ultrasound also had no suspicious LNs on prechemotherapy physical exam; among these patients, 100% had ypN1 disease. ConclusionsFor breast cancer patients who do not achieve an n-pCR after NAC, pretreatment normal clinical axillary exam and prechemotherapy ultrasound showing only one abnormal LN is associated with ypN1 disease. It may be reasonable to consider omitting completion ALND in this subset of patients while awaiting the results of the Alliance A011202 trial.