 This study developed and validated a novel nomogram model that can preoperatively predict axillary lymph node pathological complete response, PCR, after neoadjuvant therapy, NAT, and avoid unnecessary axillary lymph node dissection, ALND, for breast cancer patients. The results of this study suggest that molecular subtypes, milligram breast, CT breast, US axilla, MI axilla, and CT axilla have a significant impact on the evaluation of axillary lymph node status after NAT. Additionally, the nomogram score demonstrated a high accuracy of 0.832, 95% CI 0.786 to 0.878, in the training cohort and 0.947, 95% CI 0.906 to 0.988, in the validation cohort, suggesting its potential as a practical clinical tool. This article was offered by Pinyu Zhong, Xiong Song, Lu Hao Sun, and others.