Type Of Axillary Surgery Research Articles

Nodal Burden and Oncologic Outcomes in Patients With Residual Isolated Tumor Cells After Neoadjuvant Chemotherapy (ypN0i+): The OPBC-05/ICARO Study.

The nodal burden of patients with residual isolated tumor cells (ITCs) in the sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) (ypN0i+) is unknown, and axillary management is not standardized. We investigated rates of additional positive lymph nodes (LNs) at axillary lymph node dissection (ALND) and oncologic outcomes in patients with ypN0i+ treated with and without ALND. The Oncoplastic Breast Consortium-05/ICARO cohort study (ClinicalTrials.gov identifier: NCT06464341) retrospectively analyzed data from patients with stage I to III breast cancer with ITCs in SLNs after NAC from 62 centers in 18 countries. The primary end point was the 3-year rate of any axillary recurrence. The rate of any invasive recurrence was the secondary end point. In total, 583 patients were included, of whom 182 (31%) had completion ALND and 401 (69%) did not. The median age was 48 years. Most patients (74%) were clinically node-positive at diagnosis and 41% had hormone receptor-positive/human epidermal growth factor receptor 2-negative tumors. The mean number of SLNs with ITCs was 1.2. Patients treated with ALND were more likely to present with cN2/3 disease (17% v 7%, P < .001), have ITCs detected on frozen section (62% v 8%, P < .001), have lymphovascular invasion (38% v 24%, P < .001), and receive adjuvant chest wall (89% v 78%, P = .024) and nodal radiation (82% v 75%, P = .038). Additional positive nodes were found at ALND in 30% of patients, but only 5% had macrometastases. The 3-year rates of any axillary and any invasive recurrence were 2% (95% CI, 0.95 to 3.6) and 11% (95% CI, 8 to 14), respectively, with no statistical difference by type of axillary surgery. The nodal burden in patients with ypN0(i+) was low, and axillary recurrence after ALND omission was rare in patients selected for this approach. These results do not support routine ALND in all patients with ypN0(i+).

Financial toxicity in breast cancer patients receiving regional nodal irradiation: Variation by cancer subtype

BackgroundWe evaluated sociodemographic and clinical predictors of financial toxicity (FT) among patients with breast cancer with higher risk clinical factors warranting regional nodal irradiation (RNI). MethodsAmong 183 participants in a clinical trial of conventional vs. hypofractionated treatment with RNI, 125 (68 %) completed a pilot survey of FT measured using the validated Economic Strain and Resilience in Cancer (ENRICh) instrument, scored from 0 (minimal) to 10 (severe) FT. Associations with predictors were evaluated using Pearson correlation coefficients and Kruskal Wallis, Mann-Whitney U, and Jonckheere-Terpstra tests. Predictors of severe FT (ENRICh≥5) were tested using multivariable logistic regression with odds ratios converted to relative risks (RR). ResultsOf the sample, all received RNI, 92 % chemotherapy, 67 % axillary dissection, 26 % mastectomy without reconstruction, and 32 % mastectomy with reconstruction. At a median follow up of 1.48 years, median FT score was 2.13 (IQR 0.93–4.6), with 20.8 % of patients experiencing severe FT. Unadjusted worse FT score was associated with younger age (P = 0.003), Hispanic ethnicity (P = 0.006), lower income (P = 0.02), shorter interval from diagnosis to FT assessment (P = 0.02), and chemotherapy receipt (P = 0.05), but not with breast surgery type (P = 0.42), axillary surgery type (P = 0.33), or pathologic T (P = 0.68) or N stage (P = 0.47). In multivariable analysis, triple negative subtype was the sole clinical factor predicting severe FT (RR = 3.38; 95 % CI 1.48–4.99; P = 0.01). ConclusionAmong patients with breast cancer receiving RNI, triple negative subtype was associated with severe FT, suggesting that tumor receptor subtype may help identify a key breast cancer subpopulation for early FT intervention.

Clipping the Positive Lymph Node in Patients with Clinically Node Positive Breast Cancer Treated with Neoadjuvant Chemotherapy: Impact on Axillary Surgery in the ISPY-2 Clinical Trial

BackgroundFor patients with clinically node-positive (cN+) breast cancer undergoing neoadjuvant chemotherapy (NAC), retrieving previously clipped, biopsy-proven positive lymph nodes during sentinel lymph node biopsy [i.e., targeted axillary dissection (TAD)] may reduce false negative rates. However, the overall utilization and impact of clipping positive nodes remains uncertain.Patients and MethodsWe retrospectively analyzed cN+ ISPY-2 patients (2011–2022) undergoing axillary surgery after NAC. We evaluated trends in node clipping and associations with type of axillary surgery [sentinel lymph node (SLN) only, SLN and axillary lymph node dissection (ALND), or ALND only] and event-free survival (EFS) in patients that were cN+ on a NAC trial.ResultsAmong 801 cN+ patients, 161 (20.1%) had pre-NAC clip placement in the positive node. The proportion of patients that were cN+ undergoing clip placement increased from 2.4 to 36.2% between 2011 and 2021. Multivariable logistic regression showed nodal clipping was independently associated with higher odds of SLN-only surgery [odds ratio (OR) 4.3, 95% confidence interval (CI) 2.8–6.8, p < 0.001]. This was also true among patients with residual pathologically node-positive (pN+) disease. Completion ALND rate did not differ based on clip retrieval success. No significant differences in EFS were observed in those with or without clip placement, both with or without successful clip retrieval [hazard ratio (HR) 0.85, 95% CI 0.4–1.7, p = 0.7; HR 1.8, 95% CI 0.5–6.0, p = 0.3, respectively].ConclusionClip placement in the positive lymph node before NAC is increasingly common. The significant association between clip placement and omission of axillary dissection, even among patients with pN+ disease, suggests a paradigm shift toward TAD as a definitive surgical management strategy in patients with pN+ disease after NAC.

Abstract PO5-17-12: Impact of HER2-low status on axillary response and surgical management after neoadjuvant chemotherapy in early breast cancer

Abstract Background: Breast cancer (BC) with low expression of HER2 (HER2-low) might constitute a group of tumors with unique clinical and biological characteristics. Little is known about axillary downstaging and nodal surgical outcomes in HER2-low BC after neoadjuvant chemotherapy (NACT). The aim of this study was to evaluate axillary response and surgical management of the axilla in HER2-low BC patients submitted to NACT. Methods: In this cross-sectional single center study, we consecutively included all patients diagnosed with early HER2-negative BC between 2017 to 2021 that were treated with NACT. Patients must have biopsy-confirmed stage II-III BC, submitted to breast surgery after NACT. Clinical and pathological response in the axilla, type of axillary surgery, and surgical outcomes data were collected. HER2-low was defined by IHC score 1+, or 2+ ISH non-amplified; HER2-zero was defined by IHC score 0. Pathological response was determined locally. Results: At diagnosis, 291 patients had clinically involved axillary nodes (cN1: 69.4%; cN2: 25.1%; cN3: 5.5%). Among 136 patients eligible for SLN biopsy after NACT, 77 (26.5%) had pathologically negative SLN. Of those submitted to upfront axillary dissection (n=154), 52 (33.7%) had pN0 disease. In total, 129 (44.3%) patients with clinically involved axillary lymph nodes at diagnosis were converted to cN0 after NACT. There was no difference in the rate of axillary downstaging between HER2-low and HER2-zero tumors, 17.8% vs 26.5%, respectively (p=0.0026). 236 patients were submitted to sentinel lymph node biopsy (SLN), of whom 214 (81.4%) with blue dye-only, 40 (15.2%) with radioactive isotope, and 7 (2.7%) with dual tracer. SLN detection failure were reported for 12 patients (0.046%). Mean number of lymph nodes retrieved were 2.7. Most patients had a negative SLN biopsy (180/263; 68.4%), of whom 91 (50.6%) were HER2-low and 89 (49.4%) were HER2-zero. Positive SLN biopsy were reported in 83 patients (isolated tumor cells: 20,5%; micrometastasis: 24.1%; macrometastasis: 55.4%), with capsular extravasation in 25.3%. A positive SLN biopsy occurred in 61.4% of patients with HER2-low tumors, and in 38.5% of patients with HER2-zero tumors. Among patients with a positive SLN biopsy (n=83), 67 were submitted to axillary dissection, of whom 39 (58.2%) had no additional nodes involved (HER2-low: 61.5%; HER2-zero: 38.4%). Considering N0 tumors at diagnosis, 127 patients were submitted to SNL, and only 18.9% had a positive result (HER2-low: 66.6%; HER2-zero: 33.3%). In the subgroup of initially cN+ disease, 136 (46.7%) underwent SLN biopsy, with 59 (43.4%) with a positive result (HER2-low: 59.3%; HER2-zero: 40.7%). Conclusions: Our results showed that HER2-low BC patients had a statistically significant lower frequency of axillary downstaging after NACT. More than 40% of patients with cN+ at diagnosis were downstaged to cN0 and were submitted to SNL biopsy. Axillary dissection were avoided in roughly 25% of patients with cN+ BC at initial staging. Citation Format: Leonardo Roberto da Silva, Guilherme Sartori, Susana Ramalho, Tomás Reinert, Mahira Lopes Da Rosa, Grazielle Morais Tavares, Higor Mantovani, Vivian Vasconcelos, Ana Elisa Ribeiro Da Silva Cabello, Guilherme Coelho, Jovana Mandelli, Facundo Zaffaroni, Carlos Barrios, Marcia Silveira Graudenz, César Cabello. Impact of HER2-low status on axillary response and surgical management after neoadjuvant chemotherapy in early breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-17-12.

Abstract PO3-12-07: Utility of Volumetric Measurement for Clinical Diagnosis of Breast Cancer-Related Lymphedema

Abstract Background: Early detection of Breast cancer-related lymphedema (BCRL) is crucial since it can significantly reduce the negative impact on a patient’s quality of life after breast cancer treatment. Several objective screening methods have been used in prior studies but have not proven accurate due to a lack of standardization. Bioimpedance spectroscopy (BIS), which assesses tissue resistance to an electric current and converts it into a score to measure interstitial fluid content, has proven to be an accurate tool in diagnosing lymphedema. SOZO® is a BIS device that generates quantitative results in real time and provides a Lymphedema Index (L-Dex) score by measuring the patient's extracellular fluid volume. However, there is a paucity of literature highlighting its clinical applicability. Thus, we aimed to evaluate the clinical utility of SOZO® in diagnosing BCRL in patients undergoing breast cancer surgery. Materials &amp; Methods: A retrospective chart review was carried out of patients who underwent axillary surgery from January 2019 to December 2022. Demographic information such as age, body mass index (BMI), gender, ethnicity, disease pathology, cancer stage, type of axillary surgery, neoadjuvant and adjuvant treatment received was recorded. Patients undergoing sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND) were assessed for their preoperative L-Dex score, and they were followed up postoperatively with repeated measurements of their L-Dex score to diagnose lymphedema for a year at 3 months intervals. Clinical lymphedema was defined as those having an absolute L-Dex score of more than +10 and an increase in L-Dex score by 6.5 from the baseline. SOZO® scores measured at each follow-up were compared to their preoperative baseline scores. Results: A total of 200 patients’ data was evaluated whose mean age and BMI were 57.5+10.9 years and 29.6+5.6 kg/m2, respectively. Eighty-five percent of the patients belonged to ethnic minority groups. Furthermore, 84.5% (n=169) of the patients had SLNB, and 15.5% (n=31) had ALND. All the patients included in the study had their preoperative and postoperative quarterly L-Dex scores recorded. Pre- and post-operative L-Dex scores had a mean of -0.20+6.6 and 0.61+6.8, respectively. A total of 20 (10%) patients developed lymphedema without symptoms detected by SOZO®, with 19 (9.5%) resolving at their respective 3-month follow-up and 1 (0.5%) patient with persistent lymphedema at the end of the 24-month follow-up. All 20 patients were treated with a compression sleeve. Of the 20 patients with lymphedema, 4 patients underwent ALND, whereas 16 patients had SLNB. When compared to their preoperative baseline scores, all patients' SOZO® measurements had an absolute score of more than 10 and an increase of 6.5 from their baseline score. Additionally, 21 other patients had an increase in score of 6.5 from their baseline measurements but did not meet the cut-off range of an absolute score of +10. Therefore, we excluded them from the diagnosis of BCRL, and none of these patients later developed any signs of BCRL, such as swelling, pain, or discomfort. Conclusion: SOZO® procedure can accurately detect BCRL. In our study, 1 patient developed clinical lymphedema after undergoing SLNB and was diagnosed using SOZO®. Additionally, 19 patients who were initially diagnosed with lymphedema were later categorized as transient due to the resolution of lymphedema on follow-up. Early identification of transient lymphedema using SOZO® resulted in the prevention of a potentially life-long debilitation in our patients. Moreover, our findings underscore that an increase in SOZO® score from the baseline by &amp;gt; 6.5 with an absolute score of more than +10 should be the threshold to clinically diagnose lymphedema. Future studies with larger sample sizes and longer follow-up duration are necessary to understand better the utility of SOZO® in diagnosing BCRL. Table 1: Baseline characteristics and follow-up data of the patients included in the study. Citation Format: Fardeen Bhimani, Sheldon Feldman, Yu Chen, Anjuli Gupta, Jessica Pastoriza, Areej Shihabi, Maureen McEvoy. Utility of Volumetric Measurement for Clinical Diagnosis of Breast Cancer-Related Lymphedema [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-12-07.

Abstract PO3-22-07: Predicting Additional Axillary Metastases in Breast Cancer Patients with Positive Targeted Axillary Dissection Lymph Nodes after Neoadjuvant Treatment

Abstract Background: Neoadjuvant chemotherapy (NACT) is increasingly used for axillary downstaging in clinically node-positive breast cancer patients, and a considerable proportion achieves axillary pathological complete response (ax-pCR). After NACT, axillary staging can be done by targeted axillary dissection (TAD). In case of metastases at TAD, axillary lymph node dissection (ALND) is offered regardless of metastases size. This contrasts primary surgery, where small sentinel node metastases (ypN0(i) and ypN1mi) and ≤2 positive sentinel nodes do not confer ALND, although a proportion of patients with small metastases have additional metastatic lymph nodes (LNs) in the axilla. So far, the residual metastatic burden in the axilla when TAD LNs are positive after NACT is unknown. If subgroups of patients with low residual metastatic burden in the axilla (non-TAD LNs) could be identified, these subgroups may be offered de-escalated axillary treatment. Therefore, we investigated the risk of residual metastatic burden in the axilla when the TAD LNs harbored metastases. Methods: We retrospectively retrieved DBCG data on patients staged by TAD after NACT in Denmark between 1.1.2016-31.8.2021. We registered: age, breast biopsy date, type of surgery, type of axillary surgery, count of LNs, sentinel nodes, and marked lymph nodes with and without metastases, including metastasis size, breast tumor histology and receptor subtype, breast tumor size at diagnosis and in the surgical specimen, malignancy grade and type of neoadjuvant treatment. We excluded patients with inflammatory breast cancer, &amp;lt; 4/&amp;gt;8 cycles of NACT, or a non-standard NACT regimen. The primary outcome was risk factors for having high ( &amp;gt;3), low (1-3), or no residual metastatic burden in the axilla when the TAD LNs harbored metastases. We modeled risk factors for both high and low residual metastatic burden in the axilla using multivariable logistic regression and constructed risk models based on the regression coefficients. Results: We identified 1626 patients receiving NACT and TAD in the inclusion period. After excluding ineligible patients and patients who achieved ax-pCR with no subsequent ALND (46%), the study included 383 patients with positive LNs at TAD for further analysis: thereof 188, 127, and 68 with 0, 1-3 and &amp;gt;3 positive non-TAD LNs, respectively. In the adjusted logistic regression analysis, we found that breast pCR (OR= 0.06, 95% CI &amp;lt; .01-0.41, p &amp;lt; .001) and a low proportion of positive TAD LNs (0-66% vs &amp;gt;66%) (OR=0.32, 95% CI 0.17-0.58, p = &amp;lt; .001) were associated with low risk of high residual metastatic burden in the axilla. Patients with one or both low-risk factors present had an 8% (14 of 176 patients) risk of high residual metastatic burden in the axilla. The predictive value of the model for having &amp;lt; 3 non-TAD LN metastases was 92%. When analyzing the 315 patients with ≤3 positive non-TAD LNs, the adjusted logistic regression analysis of 1-3 vs 0 positive non-TAD LNs showed that ypN0(i) in the TAD LN (OR=0.14, 95% CI 0.04-0.53, p = 0.002), small tumor size at diagnosis (20-49 mm vs ≥ 50 mm) (OR = 0.29, 95% CI 0.14-0.60, p = 0.002), breast pCR (OR= 0.38, 95% CI 0.15-0.98, p = 0.04) and low proportion of positive TAD LNs (33-66% vs &amp;gt;66%) (OR= 0.46, 95% CI 0.27-0.77, p = 0.01) were associated with no residual metastases in the axilla. Using these risk factors, 19% (11/58) of the patients in the lowest risk quartile had further metastatic spread to the axilla. Conclusion: Based on an extensive breast cancer registry, we find that breast pCR, low proportion of positive TAD LNs, small metastases, and small tumor size are associated with low risk of residual metastatic LNs in the axilla when the TAD LNs are positive after NACT. With these risk factors, we propose two models to identify patients with low non-TAD residual metastatic burden and patients with a high likelihood of no further metastases. The models can guide breast surgeons in de-escalating axillary treatment in these groups. Citation Format: Frederikke Munck, Maj-Britt Jensen, Ilse Vejborg, Maria Gerlach, Maja Maraldo, Niels Kroman, Tove Tvedskov. Predicting Additional Axillary Metastases in Breast Cancer Patients with Positive Targeted Axillary Dissection Lymph Nodes after Neoadjuvant Treatment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-22-07.

Abstract PO4-12-03: PATIENT REPORTED OUTCOMES IN TERMS OF ARM AND SHOULDER FUNCTIONS AND QUALITY OF LIFE AND LYMPHEDEMA ARE AFFECTED BY THE STAGE, AND EXTENT OF AXILLARY SURGERY IN THE EARLY POSTOPERATIVE PERIOD OF PATIENTS WITH BREAST CANCER

Abstract This study evaluated whether lymphedema, patient-reported arm and shoulder morbidity and quality of life one year after axillary surgery are affected by stage or axillary surgery type between early stage patients and patients with locally advanced breast cancer who underwent surgery following neoadjuvant therapy. By determining the risk factors associated with severe lymphedema and deterioration of patient-reported outcomes, lymphedema could be prevented by early intervention to improve the prognosis of lymphedema and quality of life. Material and Methods: Between January 2021 and May 2022, a total of 253 breast cancer patients, 128 early stage and 125 locally advanced stage who underwent surgery including sentinel lymph node biopsy (SLNB) with/without axillary lymph node dissection (ALND) following neoadjuvant therapy were included in this study. The patients who underwent upfront surgery were defined as early-stage, and those who underwent surgery following neoadjuvant chemotherapy were considered as having locally advanced breast cancer (LABC) who have also participated in the prospective MF18-03 registry trial. Patients were prospectively evaluated by the SF-12 quality of life and QUICK-DASH hand, arm, and shoulder range of motion questionnaires and circumferential tape measurements of the arm width to evaluate the lymphedema before surgery, and 6 month- and 12-month assessments. The volume difference of 10% or more in the operated arm compared to the healthy arm was considered as lymphedema. Results: In the assessment of SF-12 quality of life questionnaire, there was a decrease in physical function scores at the 6th month despite recovery at the 12th month in both groups compared to the initial preoperative scores (p&amp;lt; 0,001). Moreover, patients with locally advanced breast cancer were found to have decreased SF-12 general health (p=0.024), vitality (p=0.034), and mental health scores in one year after surgery (p=0.004). Patients with mastectomy and locally advanced breast cancer were more likely to have a diminished arm and shoulder function as assessed with the QUICK-DASH questionnaire at the 6th and 12th months compared to those with breast conservation (6. month, p=0,009, 12. month, p=0.004), and early breast cancer, respectively (6. month, p=0.014, 12. month, p&amp;lt; 0.001) In the present cohort, lymphedema was detected in 19 (7.5%) patients including 16 cases with mild (11-20%), 2 cases with moderate (21-40%), and one case with severe (41-80%) lymphedema one year after surgery. Axillary dissection was found to be associated with an increased risk of lymphedema (SLNB, 5.0% vs ALND, 17.6%; p=0.005). Similarly, removal of &amp;gt;6 lymph nodes was also associated with an increased risk of lymphedema that was not statistically significant (&amp;lt;6 LNs, 6.4% vs &amp;gt;6LNs, 10.8%; p=0.277). Among those with LABC, however, patients with removal &amp;gt;6 LNs were more likely to have lymphedema (&amp;gt;6 LNs, 15.4% vs &amp;lt;6 LNs, 5.8%; p=0.096). Conclusion: These findings suggest that only an extensive axillary surgery was associated with an increased risk of breast cancer-related lymphedema. Patients with a mastectomy were more likely to have diminished arm and shoulder function compared to those with breast conservation. Furthermore, patients with locally advanced breast cancer were more likely to have a dispaired quality of life score and a limited arm and shoulder function regardless of the presence of lymphedema. Early prompt diagnosis and therapy of lymphedema can therefore potentially improve quality of life. Citation Format: Halime Gul Kilic, Selman Emiroglu, Ekin Ozgorgu, Mustafa Tukenmez, Atilla Bozdogan, Mahmut Muslumanoglu, Vahit Ozmen, Dilsad Sindel, Abdullah Igci, Aydan Oral, Neslihan Cabıoğlu. PATIENT REPORTED OUTCOMES IN TERMS OF ARM AND SHOULDER FUNCTIONS AND QUALITY OF LIFE AND LYMPHEDEMA ARE AFFECTED BY THE STAGE, AND EXTENT OF AXILLARY SURGERY IN THE EARLY POSTOPERATIVE PERIOD OF PATIENTS WITH BREAST CANCER [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-12-03.

Abstract PR014: Racialized economic polarization effects on postoperative complications in patients with triple negative breast cancer

Abstract INTRODUCTION The physical separation of residential housing based on race and income, otherwise known as racialized economic residential segregation, has been associated with more aggressive tumor pathology and higher mortality in patients with breast cancer. The purpose of this study is to evaluate the impact of racialized economic segregation on post-operative complications (POC) in surgical patients with triple negative breast cancer (TNBC). METHODS Women aged 18+ diagnosed with stage I-III TNBC between 1/1/12-12/31/20 who underwent surgery were identified in the cancer registry and electronic medical record at a comprehensive cancer center. Racial (ICE-race) and racialized economic (ICE-race-income) polarization were operationalized using the Index of Concentration at the Extremes (ICE) at the census tract level. Metrics were divided into quartiles where higher quartiles represented greater polarization. Postoperative complications (POC) included technical, infectious, respiratory, urinary, and cardiovascular complications within 30 days of surgery. Crude and adjusted logistic regression generalized estimating equations (GEE) assessed the association between greater racial (ICE-race) and racialized economic (ICE-race-income) segregation as exposures and POC as the outcome, while accounting for clustering effects. Models were adjusted for age, race, ethnicity, health insurance, marital status, history of alcohol and smoking use, molecular subtype, clinical stage, receipt of chemotherapy, breast and axillary surgery type, and surgical reconstruction. RESULTS 626 patients were included in the study, of whom 509 (81.4%) identified as White, 97 (15.5%) Black, and 20 (3.2%) other. Median age was 59 (IQR 49.0, 67.0) years. Average overall frequency of POC was 8.2%, with increased odds in patients living in neighborhoods with greater racial segregation (ICE-race: Q1 4.0% vs. Q4 12.3%, P=0.02) and racialized economic segregation (ICE-race-income: Q1 3.2% vs. Q4 13.4%, P=0.001). Patients with TNBC living in neighborhoods with greater racialized economic segregation had a 2.52 (95% CI: 1.22 – 5.22) adjusted odds of POC compared to patients residing in less segregated neighborhoods. A one-quartile increase in racial segregation was associated with 41% increased odds of POC (aOR 1.41, 95% CI: 1.00 – 1.98). Similarly, a one-quartile increase in racialized economic polarization was associated with 45% increased odds of POC (aOR 1.45, 95% CI: 1.05 - 2.01). CONCLUSIONS Patients with TNBC breast cancer residing in areas with greater racial segregation or racialized economic segregation are more likely to experience postoperative complications than their counterparts in less segregated areas. Future studies need to examine the mechanistic pathways between neighborhood contextual factors and poor postoperative outcomes. Citation Format: J.C. Chen, Mohamed I. Elsaid, Jesse J. Plascak, Daniel G. Stover, William E. Carson, Timothy M. Pawlik, Samilia Obeng-Gyasi. Racialized economic polarization effects on postoperative complications in patients with triple negative breast cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR014.

Is it the Type of Axillary Surgery or the Number of Removed Lymph Nodes That Increases the Risk of Breast Cancer Related Lymphedema (BCRL)? Results from a Prospective Screening Trial

Axillary surgery has been identified as the main risk factor for BCRL regardless the delivery of regional nodal radiation (RLNR). Yet it remains unknown if it is the type of axillary surgery or the number of removed lymph nodes (LN) that increases BCRL risks. Between 2008 and 2021, 3,350 patients (pts) who received surgery for breast cancer were enrolled in a lymphedema screening trial. Patients with bilateral breast cancer or without axillary surgery were excluded. Perometry was used to assess limb volume preoperatively in all patients. BCRL was defined as a ≥10% relative arm-volume increase arising >3 months postoperatively. The cohort was divided by axillary surgery type: axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). Radiation was delivered using 3D conformal technique and RLNR was defined as the usage of anterior supraclavicular field. No hypofractionation was used and doses ranged between 50 and 50.4 Gy in 25-28 fractions. Multivariable Cox proportional hazard models compared the cumulative incidence of BCRL and local failure between different patient groups. After applying inclusion criteria, 2,623 pts were available with overall median follow-up s of 6.1 years. Of the entire cohort, 709 (27%) had ALND with a median of 16 LN removed, while 1,914 (73%) received SLNB only with a median of 2 LN removed. The median number of malignant LN and patients receiving RLNR was higher in ALND group compared to SLNB only group. Frequency distribution analysis showed that the main overlap between ALND and SLNB only groups happen in the range of 3-11 LN removed. Therefore, the primary analysis focused only on pts with 3-11 LN across both groups (n = 690: ALND n = 140, SLNB n = 550). The multivariable model adjusted for BMI, RLNR, age and breast surgery showed that in this group with 3-11 LN removed in both cohorts, ALND remained significantly associated with BCRL (HR: 4.2, p<0.0001). Separate analyses for the entire SLNB only group and ALND groups were conducted to evaluate if the BCRL risk increases per each removed LN within the same axillary surgery group. The multivariable analysis for SLNB only pts(N = 1,914) showed that for each LN removed the risk of BCRL did not increase significantly (HR:1.06, p = 0.3), similarly for ALND group (N = 709) for each LN removed (HR:1.02, p = 0.08). For pts with pathologic N2-N3 disease and clinical node negative without neoadjuvant chemotherapy receiving ALND, the number of LN removed did not significantly improve neither Local control (HR:1.02, p = 0.8) nor distant disease survival (HR:1.01, p = 0.6). ALND procedure per se is the main risk factor for BCRL not the number of LNs removed. For high-risk pts with >N2 disease, aggressive ALND did not improve tumor outcome. De-escalation with targeted axillary sampling followed by RLNR should be evaluated. Future lymphedema research should account for type of axillary surgery instead of number of LNs removed as a factor. (NCT01521741).

Sentinel Lymph Node Biopsy in Breast Cancer Patients Undergoing Neo-Adjuvant Chemotherapy: Clinical Experience with Node-Negative and Node-Positive Disease Prior to Systemic Therapy

Sentinel lymph node biopsy (SLNB) has emerged as the standard procedure to replace axillary lymph node dissection (ALND) in breast cancer (BC) patients undergoing neo-adjuvant chemotherapy (NAC). SLNB is accepted in clinically node-negative (cN0) patients; however, its role in clinically node-positive (cN+) patients is debatable. We performed a retrospective analysis of BC patients undergoing NAC and SLNB. Our aim was to evaluate the clinical significance of SLNB in the setting of NAC. This was accomplished by comparing the characteristics and oncological outcomes between cN0 and cN+ patients prior to NAC and type of axillary surgery. A total of 291 patients were included in the analysis: 131 were cN0 and 160 were cN+ who became ycN0 after NAC. At a median follow-up of 43 months, axillary recurrence occurred in three cN0 (2.3%) and two cN+ (1.3%) patients. However, there were no statistically significant differences in oncological outcomes (disease-free survival, distant disease-free survival, overall survival, and breast-cancer-specific survival) between cN0 and cN+ patients nor between patients treated with SLNB only or ALND. SLNB in the setting of NAC is an acceptable procedure with a general good prognosis and low axillary failure rates for both cN0 and cN+ patients.

Prognostic Importance of Nodal Microenvironment beyond Extracapsular Extension in Breast Cancer Outcomes

<h3>Purpose/Objective(s)</h3> Lymph node (LN) involvement and extracapsular extension (ECE) play important roles in breast cancer risk stratification, management, and outcome. Involvement of other axillary tissues (AXT) excised during surgery is often omitted in pathology reports and its prognostic significance is yet to be elucidated. <h3>Materials/Methods</h3> Medical records of 1,919 breast cancer patients with pathologic lymph nodes treated at our institution from 2000-2019 was retrospectively reviewed. Extensive details of LN involvement are reported by pathologists at our institution and were divided into 4 groups: LN+ only, LN+ECE, LN+AXT without ECE, and LN+ECE+AXT. AXT was defined as the involvement of lymphatic vessels, blood vessels, soft tissue metastasis, matted unspecified masses and combination of any of those forms. The primary endpoint was the impact of AXT on locoregional failure (LRF) defined as recurrence in either breast/chest wall/axilla/supraclavicular fossa, on axillary failure (AF) defined as recurrence in the axilla only and on distant failure (DF) defined as metastasis. Subgroup analysis explored the differences between types of AXT and Cox Hazard models were used. <h3>Results</h3> Among 1,919 patients analyzed, 995 had LN+ only involvement, 534 had LN+ECE, 81 had LN+AXT without ECE, and 309 had LN+ECE+AXT. The overall median follow-up was 6.5 years. The 10 years cumulative incidence of LRF was 5.9%, 6.4%, 11.8% and 10.9% in LN only, LN+ECE, LN+AXT without ECE and LN+ECE+AXT groups, respectively. The 10 years cumulative incidence of AF was 0.92%, 0.83%, 4.1% and 4.4% in LN+ only, LN+ECE, LN+AXT without ECE and LN+ECE+AXT groups, respectively. The 10 years cumulative incidence of DF was 15.7%, 23%, 23.5% and 42.1% in LN+ only, LN+ECE, LN+AXT without ECE and LN+ECE+AXT groups, respectively. On multivariable analysis controlling for number of malignant LN, ECE, tumor biology, grade and size, type of axillary surgery and radiation dose delivered to the draining lymphatics, the presence of other AXT was significantly associated with LRF (HR:2.3, P<0.01), AF (HR:4.7, P<0.01) and DF (HR: 1.4, P=0.02). ECE and number of malignant LN were not associated with LRF and AF, but rather associated with DF (HR:1.4, P=0.009 and HR:1.03, P=0.002, respectively). Delivery of 50 Gy or more to draining lymphatics was associated with better axillary control (HR:0.3, P=0.01) compared to 45 Gy. No significant difference between 45 Gy and 50 Gy to the lymphatics was observed for LRF and DF. Subgroup analysis did not show a difference between the described forms of AXT on LRF and DF. <h3>Conclusion</h3> Pathologic evaluation of the axilla's microenvironment beyond tumor deposits in lymph nodes and ECE is important to ensure adequate local control in the axilla. Given the higher risk of recurrence posed by tumor infiltration into surrounding axillary tissues, delivery of at least 50Gy to lymphatics should be considered. Our findings demonstrate the need for pathology reports to include assessment of the axilla's microenvironment.

Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study

BackgroundPostmastectomy pain syndrome (PMPS) is a common postoperative condition after breast cancer surgery. PurposeThe aim of this study was to investigate the incidence rate and risk factors of PMPS, and to propose prevention and treatment methods. MethodsThe study included 1790 postoperative breast cancer patients from three hospitals from 2017 to 2021, of which 302 (13.0%) patients with PMPS were included in the study. ResultsAge, breast surgery type, axillary surgery type and radiotherapy are the risk factors of PMPS. Age, radiotherapy and chemotherapy affect the pain degree of PMPS during movement. ConclusionsFor breast cancer patients with high risk factors, pain should be actively prevented during perioperative period. Oral pharmacological agents, multidisciplinary combination therapy, local anesthetics and regional anesthesia are the most common treatment of PMPS.

Impact of Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy on Upper Limb Morbidity in Breast Cancer Patients: A Systematic Review and Meta-Analysis.

To evaluate the impact of axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) on upper limb (UL) morbidity in breast cancer patients. Axillary de-escalation is motivated by a desire to reduce harm of ALND. Understanding the impact of axillary surgery and disparities in operative procedures on postoperative arm morbidity would better direct resources to the point of need and cement the need for de-escalation strategies. Embase, MEDLINE, CINAHL, and PsychINFO were searched from 1990 until March 2020. Included studies were randomized-controlled and observational studies focusing on UL morbidities, in breast surgery patients. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of UL morbidity comparing SLNB and ALND at <12 months, 12 to 24 months, and beyond 24 months were analyzed. Sixty-seven studies were included. All studies reported a higher rate of lymphedema and pain after ALND compared with SLNB. The difference in lymphedema and pain prevalence between SLNB and ALND was 13.7% (95% confidence interval: 10.5-16.8, P <0.005) and 24.2% (95% confidence interval: 12.1-36.3, P <0.005), respectively. Pooled estimates for prevalence of reduced strength and range of motion after SLNB and ALND were 15.2% versus 30.9% and 17.1% versus 29.8%, respectively. Type of axillary surgery, greater body mass index, and radiotherapy were some of the predictors for UL morbidities. Prevalence of lymphedema after ALND was higher than previously estimated. ALND patients experienced greater rates of lymphedema, pain, reduced strength, and range of motion compared with SLNB. The findings support the continued drive to de-escalate axillary surgery.

Abstract DEB1-2: Con - RxPONDER: Was it all OFS?

Abstract Introduction: In Rx ponder patients with nodal involvement and a recurrence score between 0-25 were randomised to receive either chemotherapy followed by endocrine therapy or endocrine therapy alone. Patients were stratified by recurrence score (RS) 0-13 vs 14-25, menopausal status and type of axillary surgery. 50% of the patients randomised to chemotherapy received TC (4 or 6 cycles) and ovarian function suppression (OFS) was used in 16% in the ET arm and 3% in the chemotherapy plus ET arm (CET). 33% of the patients enrolled were premenopausal. The overall analysis demonstrated that patients with CET had a significantly higher iDFS at 5 years than those with ET (92.4% vs 91%); HR 0.81, p=0.026. There was a significant interaction of menopausal status and chemotherapy. 5-year iDFS was 94.2% with CET and 89% with ET (delta 5.2%); HR 0.54; p=0.0004, which was larger in the group with a RS 13-25. Because the use of OFS in the CET arm was only 3% it was hypothesised that the main effect of chemotherapy is due to ovarian function suppression. Main Part: OFS added to tamoxifen or AI is very effective in premenopausal women as shown by the SOFT and TEXT studies. The majority of women in SOFT and TEXT received chemotherapy and the effect was observed mainly in the group receiving chemotherapy (a surrogacy for high risk). Adding OFS to tamoxifen plus chemotherapy vs chemotherapy plus tamoxifen is better. The LHRH metaanalysis demonstrated that LHRH was about equally effective to chemotherapy. However, the majority of trials used 2 years LHRH, chemotherapy consisted mainly of CMF and the effect was seen in women under 40 years. The subsequent metaanalyses by the EBCTCG support chemotherapy regardless of ET and menopausal status. Anthracycline and taxane containing chemotherapy is more effective than CMF and dose-dense chemotherapy is even more effective than standard chemotherapy. Chemotherapy can induce amenorrhoea and women with chemotherapy induced amenorrhea have a better outcome than those without. Cyclosphosphamide and especially in the CMF regimen have the highest rate of amenorrhea and the main effect is seen in women between 40 and 50 years. Younger women regain menses, so the ovarian function suppression is temporarily, especially in women below 40 years. The dose of cyclophosphamide in the TC regimen, which was predominantly used in Rx-Ponder is lower than in the CMF regimen but similar to modern type chemotherapy regimen. In RX-Ponder the chemotherapy effect was seen in all premenopausal women but there was no difference of the point estimate in women between 40-50 and younger than 40 years of age. The ovarian function suppression effect is transient and women under 40 year of age tend to regain menopause and should receive an LHRH in addition. In very young women the ovarian function suppression with an LHRH analogue is about 80% leaving 20% without adequate OFS. The toxicity rate of 5 years of LHRH containing ET is high and should not be underestimated compared to 4-6 months chemotherapy. Compliance of LHRH is lower than in adjuvant chemotherapy affecting the effectiveness of adjuvant therapy. If LHRH is discontinued at 2years of LHRH the patient will receive only tamoxifen, which is too little in high risk, premenopausal women. The recurrence score mainly measures endocrine sensitivity of the tumour which does not imply chemoresistance. Nodal status remains still the most important prognostic factor and chemotherapy reduces the risk of recurrence by 30-40%.The data from Rx-Ponder are comparable to the data generated in the Mindact trial. In women younger than 50 years being at clinical high risk but with a genomic low risk tumour chemotherapy improved 8-year DDFS to 93.6% compared to 88.6% without chemotherapy (HR 0.54 95%; CI 0.30-0.98).In conclusion: Premenopausal women with node-positive HR+/HER2- breast cancer benefit from the use of chemotherapy in addition to LHRH even if the RS indicates a biological low risk. Citation Format: S Loibl. Con - RxPONDER: Was it all OFS? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr DEB1-2.

Axillary surgery and complication rates after mastectomy and reconstruction for breast cancer: an analysis of the NSQIP database.

Some series have shown increased complications with extended nodal surgery and immediate breast reconstruction (IBR) with implants. We aim to explore complications associated with axillary dissection compared to sentinel lymph node biopsy at a population level. American College of Surgeons National Surgical Quality Improvement Program participant user files from 2008-2018 were searched to create a cohort of female patients undergoing unilateral mastectomy with IBR and axillary surgery for non-metastatic breast cancer. Patients were classified as having sentinel lymph node biopsy (SLNB), axillary dissection (ALND), or sentinel lymph node biopsy and axillary dissection (SLNB + ALND). Baseline demographics were compared, and multivariable logistic regression was to assess for independent predictors of the primary outcome of 30-day morbidity. Between 2008 and 2018, 18,232 patients had mastectomy and IBR with axillary surgery; 12,632 patients underwent SLNB, 3727 had ALND and 1,873 underwent SLNB + ALND. Mean age of patients in the cohort was 52.5 (SD 11). There was no difference in 30-day morbidity between groups (SLNB: 4.3%, ALND: 4.9%, SLNB + ALND: 4.2%, p = 0.207). Multivariable regression showed that type of axillary surgery was not an independent predictor of 30-day complications (OR 0.78 (95% CI 0.52-1.15) for ALND, and OR 0.87 (95% CI 0.52-1.45) for ALND + SLNB vs SLNB alone). Significant independent predictors for complications were increased BMI (OR 1.06 (95%CI 1.04-1.08)) and increased operative time (OR 1.003 (95% CI 1.001-1.005)). ALND does not increase 30-day morbidity in patients undergoing IBR when compared to SLNB. This supports concurrent axillary dissection for IBR patients when indicated.

Axillary Management After Neoadjuvant Endocrine Therapy for Hormone Receptor-Positive Breast Cancer.

Data to guide axillary management after neoadjuvant endocrine therapy (NET) remain limited. We analyzed type of axillary surgery [sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND)] and residual nodal disease burden after NET in two cohorts of patients with cT1-4N0-1M0 hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer: Dana-Farber/Brigham and Women's Cancer Center (DFBWCC) cohort (2015-2018) and the National Cancer DataBase (NCDB) cohort (2012-2016). Cox proportional hazard regression was used to determine adjusted 5-year overall survival (OS) by type of axillary surgery. Ninety-four (4.3%) of 2191 HR+/HER2- DFBWCC patients and 4363 (1.5%) of 283,344 NCDB patients were selected for NET. Of those who underwent axillary surgery, 30 (43.5%) in the DFBWCC cohort and 1583 (40.6%) in the NCDB cohort had ALND. Over 90% of cN0 patients in both cohorts had fewer than three positive nodes on final pathology [44 (95.7%) DFBWCC and 2945 (91.3%) NCDB]. In contrast, only 7 (30.4%) DFBWCC patients and 342 (50.7%) NCDB cN1 patients had fewer than three positive nodes. In the DFBWCC patients, there were no locoregional recurrences and four distant recurrences. In the NCDB, 5-year OS did not differ by type of axillary surgery regardless of residual nodal disease burden: 96.6% SLNB versus 97.9% ALND for 0 positive nodes; 84.4% versus 84.4% for one to two positive nodes, and 75.9% versus 77.3% for three or more positive nodes (all p > 0.10). In cN0 patients selected for NET, > 90% have fewer than three positive nodes at surgery. The lack of a survival difference between SLNB and ALND suggests an opportunity to de-escalate treatment of the axilla in patients with limited residual nodal disease.

Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer-Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial.

To independently evaluate the impact of axillary surgery type and regional lymph node radiation (RLNR) on breast cancer-related lymphedema (BCRL) rates in patients with breast cancer. From 2005 to 2018, 1,815 patients with invasive breast cancer were enrolled in a lymphedema screening trial. Patients were divided into the following 4 groups according to axillary surgery approach: sentinel lymph node biopsy (SLNB) alone, SLNB+RLNR, axillary lymph node dissection (ALND) alone, and ALND+RLNR. A perometer was used to objectively assess limb volume. All patients received baseline preoperative and follow-up measurements after treatment. Lymphedema was defined as a ≥ 10% relative increase in arm volume arising > 3 months postoperatively. The primary end point was the BCRL rate across the groups. Secondary end points were 5-year locoregional control and disease-free-survival. The cohort included 1,340 patients with SLNB alone, 121 with SLNB+RLNR, 91 with ALND alone, and 263 with ALND+RLNR. The overall median follow-up time after diagnosis was 52.7 months for the entire cohort. The 5-year cumulative incidence rates of BCRL were 30.1%, 24.9%, 10.7%, and 8.0% for ALND+RLNR, ALND alone, SLNB+RLNR, and SLNB alone, respectively. Multivariable Cox models adjusted for age, body mass index, surgery, and reconstruction type showed that the ALND-alone group had a significantly higher BCRL risk (hazard ratio [HR], 2.66; P = .02) compared with the SLNB+RLNR group. There was no significant difference in BCRL risk between the ALND+RLNR and ALND-alone groups (HR, 1.20; P = .49) and between the SLNB-alone and SLNB+RLNR groups (HR, 1.33; P = .44). The 5-year locoregional control rates were similar for the ALND+RLNR, ALND-alone, SLNB+RLNR, and SLNB-alone groups (2.8%, 3.8%, 0%, and 2.3%, respectively). Although RLNR adds to the risk of lymphedema, the main risk factor is the type of axillary surgery used.

Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database.

The Z0011 trial demonstrated that axillary lymph node dissection (ALND) could be omitted in spite of 1–2 metastatic sentinel lymph nodes. This study aimed to validate the results on a population-based database. The Surveillance, Epidemiology, and End Results (SEER) database was searched for patients comparable to the Z0011 participants. The type of axillary surgery was estimated using the total number of examined axillary lymph nodes (ALNs). Breast cancer-specific mortality (BCSM) was compared between patients with ≥10 ALNs (the sentinel lymph node dissection (SLND) and ALND group, or “SLND + ALND group”) and patients with one or two ALNs (the “SLND group”). During 2010–2015, the SEER database included 7077 and 6620 patients categorized in the SLND group and the SLND + ALND group, respectively. Death was observed for 515 patients (7.3%) in the SLND group and 589 patients (8.9%) in the SLND + ALND group based on a median follow-up of 41 months. After propensity-score matching, the adjusted hazard ratio for BCSM in the SLND group (vs. the SLND + ALND group) was 1.038 (95% confidence interval: 0.798–1.350). Regardless of the SLND criteria, the outcomes were not significantly different between the two groups. This retrospective cohort study of Z0011-comparable patients revealed that ALND could be omitted based on the Z0011 strategy, even among patients with ≤2 dissected ALNs.

De-escalation of axillary surgery in breast cancer patients treated in the neoadjuvant setting: a Dutch population-based study

PurposeAn overall trend is observed towards de-escalation of axillary surgery in patients with breast cancer. The objective of this study was to evaluate this trend in patients treated with neoadjuvant systemic therapy (NST).MethodsPatients with cT1-4N0-3 breast cancer treated with NST (2006–2016) were selected from the Netherlands Cancer Registry. Patients were classified by clinical node status (cN) and type of axillary surgery. Uni- and multivariable logistic regression analyses were performed to determine the clinicopathological factors associated with performing ALND in cN+ patients.ResultsA total of 12,461 patients treated with NST were identified [5830 cN0 patients (46.8%), 6631 cN+ patients (53.2%)]. In cN0 patients, an overall increase in sentinel lymph node biopsy (SLNB) only (not followed by ALND) was seen from 11% in 2006 to 94% in 2016 (p < 0.001). SLNB performed post-NST increased from 33 to 62% (p < 0.001). In cN+ patients, an overall decrease in ALND was seen from 99% in 2006 to 53% in 2016 (p < 0.001). Age (OR 1.01, CI 1.00–1.02), year of diagnosis (OR 0.47, CI 0.44–0.50), HER2-positive disease (OR 0.62, CI 0.52–0.75), clinical tumor stage (T2 vs. T1 OR 1.32, CI 1.06–1.65, T3 vs. T1 OR 2.04, CI 1.58–2.63, T4 vs. T1 OR 6.37, CI 4.26–9.50), and clinical nodal stage (N3 vs. N1 OR 1.65, CI 1.28–2.12) were correlated with performing ALND in cN+ patients.ConclusionsALND decreased substantially over the past decade in patients treated with NST. Assessment of long-term prognosis of patients in whom ALND is omitted after NST is urgently needed.

Placement of Subcutaneous Central Venous Ports in Breast Cancer Patients: Does Side Matter?

BackgroundCentral venous ports placed for breast cancer treatment have traditionally been placed contralateral to the disease. This is done out of concern for the possibility of an increased risk of complications with ipsilateral port placement. There have been only a few small studies evaluating complication rates between ports placed ipsilateral versus contralateral to the breast cancer. We sought to determine if there was a difference in port complications or lymphedema rates by location. MethodsA single institution retrospective review was conducted of adult (aged >18 y) females undergoing central venous port placement for breast cancer treatment from 2012 to 2016. ResultsA total of 581 females were identified with a mean age of 52.9 ± 11.7 y. Ipsilateral ports were placed in 41 patients (7.1%). Ipsilateral ports were more likely to be placed via the internal jugular vein (56.1%), whereas contralateral ports were more likely to be placed in the subclavian vein (67.2%; P = 0.002). There was no difference between stage at diagnosis (P = 0.059), type of breast surgery (P = 0.999), axillary surgery (P = 0.087), or administration of radiation therapy (P = 0.684) between the groups. Ipsilateral ports were more likely to be on the right side, 73.2% versus 51.1% (P = 0.006). Port complications requiring intervention occurred in 3 patients (7.3%) with ipsilateral port and 33 patients (6.1%) with contralateral ports (P = 0.73). Lymphedema occurred in 8 patients (20%) with ipsilateral ports and 118 patients (21.9%) with contralateral ports (P = 0.639). On multivariable analysis, the type of axillary surgery (P = 0.003) was associated with upper extremity lymphedema, whereas port sidedness (P = 0.26) was not. ConclusionsThere was no difference in port complications or lymphedema rates between patients who had ports placed on the ipsilateral side compared with the contralateral side for breast cancer treatment.