To determine the proper treatment strategy for patients with HR+HER2- breast cancer who had 1–2 suspicious ALNs on pretreatment breast magnetic resonance imaging (MRI), we explored the clinicopathologic factors related to multiple ALNs metastases in patients who underwent upfront surgery and axillary pCR in patients who received neoadjuvant chemotherapy. The gene discussed is ERBB2; the disease is breast carcinoma.