<h4>Background</h4>Accurately predicting axillary lymph node metastasis (ALNM) preoperatively is crucial for optimizing management in patients with clinically node-negative (cN0) hormone receptor-positive (HR+) breast cancer (BC).<h4>Methods</h4>We retrospectively analyzed 816 cN0 HR+ BC patients (2016-2024). Here, NR4A1 is linked to metastatic malignant neoplasm in the lymph nodes.