---
title: "On-treatment core needle biopsy predicts axillary pCR to guide axillary surgery de-escalation"
id: "british-journal-of-cancer-0-on-treatment-core-needle-biopsy-identifies-early-responders-for-axillary"
canonical_url: "https://medichelpline.com/clinical-feed/british-journal-of-cancer-0-on-treatment-core-needle-biopsy-identifies-early-responders-for-axillary"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "British Journal of Cancer"
source_url: "https://www.nature.com/articles/s41416-026-03583-y"
published_at: "2026-08-27T12:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# On-treatment core needle biopsy predicts axillary pCR to guide axillary surgery de-escalation
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/british-journal-of-cancer-0-on-treatment-core-needle-biopsy-identifies-early-responders-for-axillary
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** British Journal of Cancer
- **Source URL:** [Original Journal Publication](https://www.nature.com/articles/s41416-026-03583-y)
- **Published At:** 2026-08-27T12:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This prospective cohort (2013–2021) evaluated the use of **on-treatment core needle biopsy (CNB)** of the primary breast tumor performed after 2–4 cycles of **neoadjuvant chemotherapy (NACT)** to identify early responders for possible axillary surgery de-escalation. - Early responders were defined as patients with **no residual disease on on-treatment CNB**. The study compared CNB results with final axillary pathologic complete response (axillary pCR) and survival. - The cohort included 1,693 patients; the overall **axillary pCR rate was 54.3%**. - Among 500 early responders by on-treatment CNB, **83.4% achieved axillary pCR** on final pathology. - In clinically node-negative (cN0) patients who were early responders, **98.0% (99/101)** had no nodal disease at surgery. - For clinically node-positive (cN+) early responders, **79.7%** achieved axillary pCR; this increased to **89.6%** when early-response CNB results were combined with **post-treatment MRI complete response**. - Subgroup MRI-combined axillary pCR rates included **92.6% in cN1** and **90.0% in cN2** patients when CNB and MRI were concordant for complete response. - Survival analysis showed that early responders had superior five-year overall survival (OS) and event-free survival (EFS) among patients with **hormone receptor–negative (HR-negative)** tumors (reported p < 0.001). - The authors conclude that on-treatment CNB reliably identifies patients likely to achieve axillary pCR and could inform strategies to de-escalate axillary surgery and tailor systemic or surgical treatment. - Data availability: original contributions are included in the article and supplementary material. Details on procedural technique, exact patient selection beyond reported categories, and specific adverse events or morbidity for CNB were not reported in the source preview.
## Clinical Analysis & Structured Key Points
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[nature](https://www.nature.com/) 2. [british journal of cancer](https://www.nature.com/bjc) 3. [articles](https://www.nature.com/bjc/articles?type=article) 4. article * Article * Published: 27 August 2026 Clinical Study # On-treatment core needle biopsy identifies early responders for axillary surgery de-escalation: results from a prospective cohort * [Yifan Xie](https://www.nature.com/articles/s41416-026-03583-y#auth-Yifan-Xie-Aff1-Aff2)[1](https://www.nature.com/articles/s41416-026-03583-y#Aff1),[2](https://www.nature.com/articles/s41416-026-03583-y#Aff2) [na1](https://www.nature.com/articles/s41416-026-03583-y#na1), * [Siyu Wu](https://www.nature.com/articles/s41416-026-03583-y#auth-Siyu-Wu-Aff1-Aff2)[1](https://www.nature.com/articles/s41416-026-03583-y#Aff1),[2](https://www.nature.com/articles/s41416-026-03583-y#Aff2) [na1](https://www.nature.com/articles/s41416-026-03583-y#na1), * [Yan Huang](https://www.nature.com/articles/s41416-026-03583-y#auth-Yan-Huang-Aff2-Aff3)[2](https://www.nature.com/articles/s41416-026-03583-y#Aff2),[3](https://www.nature.com/articles/s41416-026-03583-y#Aff3) [na1](https://www.nature.com/articles/s41416-026-03583-y#na1), * [Ying Zhang](https://www.nature.com/articles/s41416-026-03583-y#auth-Ying-Zhang-Aff1-Aff2)[1](https://www.nature.com/articles/s41416-026-03583-y#Aff1),[2](https://www.nature.com/articles/s41416-026-03583-y#Aff2) [na1](https://www.nature.com/articles/s41416-026-03583-y#na1), * [Miao Mo](https://www.nature.com/articles/s41416-026-03583-y#auth-Miao-Mo-Aff2-Aff4)[2](https://www.nature.com/articles/s41416-026-03583-y#Aff2),[4](https://www.nature.com/articles/s41416-026-03583-y#Aff4), * [Yajia Gu](https://www.nature.com/articles/s41416-026-03583-y#auth-Yajia-Gu-Aff2-Aff3)[2](https://www.nature.com/articles/s41416-026-03583-y#Aff2),[3](https://www.nature.com/articles/s41416-026-03583-y#Aff3), * [Zhimin Shao](https://www.nature.com/articles/s41416-026-03583-y#auth-Zhimin-Shao-Aff1-Aff2)[1](https://www.nature.com/articles/s41416-026-03583-y#Aff1),[2](https://www.nature.com/articles/s41416-026-03583-y#Aff2) & * … * [Guangyu Liu](https://www.nature.com/articles/s41416-026-03583-y#auth-Guangyu-Liu-Aff1-Aff2) [ORCID: orcid.org/0000-0001-5464-4395](https://orcid.org/0000-0001-5464-4395)[1](https://www.nature.com/articles/s41416-026-03583-y#Aff1),[2](https://www.nature.com/articles/s41416-026-03583-y#Aff2) Show authors [_British Journal of Cancer_](https://www.nature.com/bjc) (2026) [Cite this article](https://www.nature.com/articles/s41416-026-03583-y#citeas) [ Save article ](https://www.nature.com/articles/s41416-026-03583-y/save-research?_csrf=OAchJL4aLRJy--ZjeAKNyB8ZTG96Id79) [ View saved research ](https://www.nature.com/saved-research) ## Abstract ### Background Increasing axillary pathologic complete response (pCR) rates after neoadjuvant chemotherapy (NACT) challenge the need for routine axillary surgery. On-treatment core needle biopsy (CNB) can assess early response, but its predictive and prognostic value for axillary surgery de-escalation remains unclear. ### Methods This prospective cohort included breast cancer patients receiving on-treatment CNB (after 2-4 cycles) of the primary tumor during NACT (2013–2021). Early responders were defined as having no residual disease of on-treatment CNB. These results were compared with axillary pCR and survival outcomes. ### Results The overall axillary pCR rate of 1693 patients was 54.3%. Of 500 early responders, 83.4% achieved axillary pCR. In clinically node-negative (cN0) patients, 98.0% (99/101) of those early responders presented with no nodal disease. While 79.7% of cN+ early responders achieved axillary pCR, this rate increased to 89.6% when combined with post-treatment MRI complete response (92.6% in cN1 and 90.0% in cN2 patients). Survival analysis revealed early responders with superior five-year overall and event-free survival with HR-negative tumors (_p_ < 0.001). ### Conclusions On-treatment CNB reliably identifies patients likely to achieve axillary pCR, offering an approach to guide de-escalation strategies and potentially identifying patients who may benefit from tailored systemic and surgical treatments. 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