oncotypedx recurrence score does not predict nodal burden in clinically node negative breast cancer patients background oncotypedx recurrence score rs has been found to predict recurrence and diseasefree survival in patients with node negative breast cancer whether rs is useful in guiding locoregional therapy decisions is unclear we sought to evaluate the relationship between rs and lymph node burdenmethods patients with invasive breast cancer who underwent sentinel lymph node dissection from 2010 to 2015 were identified from a prospectively maintained database patients were excluded if they were clinically node positive or if they received neoadjuvant chemotherapy rs was classified as low 30 the association between rs lymph node burden and disease recurrence was evaluated statistical analyses were performed in r version 340 p005 was considered significantresults a positive sln was found in 168 15 of 1121 patients completion axillary lymph node dissection was performed in 84 50 of slnpositive patients the remaining 84 50 patients had one to two positive slns and did not undergo further axillary surgery rs was low in 585 intermediate in 326 and high in 89 rs was not associated with a positive sln number of positive nodes maximum node metastasis size or extranodal extension the median followup was 23 months high rs was not associated with locoregional recurrence p007 but was significantly associated with distant recurrence p00015conclusions oncotypedx rs is not associated with nodal burden in women with clinically nodenegative breast cancer suggesting that rs is not useful to guide decisions regarding extent of axillary surgery for these patients