相当比例的临床淋巴结阳性 (cN) 乳腺癌患者涉及腋窝反向标测 (ARM) 淋巴结。然而，新辅助化疗 (NAC) 可有效降低 cN 患者淋巴结转移的发生率。本研究纳入了 145 名经超声引导细针抽吸细胞学检查证实淋巴结受累的 cN 患者：一组接受了腋窝淋巴结转移不进行 NAC 的淋巴结清扫术（ALND）（前期手术组），另一组在 NAC 后进行 ALND（NAC 组）。患者术前行~(18)F-FDG-正电子发射断层扫描/计算机断层扫描(~(18)F-FDG-PET/CT),ALND期间行ARM手术,NAC组ARM淋巴结受累率明显低于NAC组前期手术组的比例（36.6% vs. 62.2%，p < 0.01）。值得注意的是，与管腔型肿瘤相比，NAC 后非管腔型肿瘤的受累显着减少（18.4% 对比 48.5%：p < 0.01）。此外，在有或没有腋窝摄取 18F-FDG 的患者之间，NAC 后 ARM 淋巴结受累情况存在显着差异（61.5% vs. 32.5%：p < 0.01）。NAC 显​​着降低了 cN 患者中 ARM 淋巴结转移的风险，但~(18)F-FDG-PET/CT不适合检测NAC后腋窝残留转移灶。

Axillary reverse mapping (ARM) nodes are involved in a significant proportion of clinically node-positive (cN+) breast cancer patients. However, neoadjuvant chemotherapy (NAC) is effective at decreasing the incidence of nodal metastases in cN+ patients.One hundred forty-five cN+ patients with confirmed nodal involvement on ultrasound-guided fine needle aspiration cytology were enrolled in this study: one group underwent axillary lymph node dissection (ALND) without NAC (upfront surgery group), and the other group underwent ALND following NAC (NAC group). The patients underwent 18F-FDG-positron emission tomography/computed tomography (18F-FDG-PET/CT) before surgery, as well as an ARM procedure during ALND.the rates of involvement of ARM nodes in the NAC group were significantly lower than those of the upfront surgery group (36.6% vs. 62.2%, p < 0.01). Notably, involvement was significantly decreased after NAC in non-luminal-type tumors as compared to the luminal-type (18.4% vs. 48.5%: p < 0.01). Moreover, there was a significant difference in ARM node involvement after NAC between patients with or without axillary uptake of 18F-FDG (61.5% vs. 32.5%: p < 0.01).NAC significantly decreased the risk of ARM node metastases in cN+ patients, but 18F-FDG-PET/CT was not suitable to detect residual metastatic disease of the axilla after NAC.