Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using...

Area of Science:

• Oncology
• Surgical Pathology
• Breast Cancer Research

Background:

• Accurate staging of breast cancer nodal metastasis is crucial for treatment planning.
• Neoadjuvant therapy is increasingly used, necessitating reliable methods to assess treatment response in lymph nodes.
• Sentinel lymph node dissection (SLND) alone can have a significant false-negative rate (FNR).

Purpose of the Study:

• To evaluate if pathologic changes in clipped nodes correlate with overall nodal basin status after neoadjuvant therapy.
• To determine if targeted axillary dissection (TAD), incorporating SLND and clipped node removal, improves the FNR compared to SLND alone.
• To assess the utility of clip placement in biopsy-confirmed metastatic nodes for guiding axillary surgery.

Main Methods:

• Prospective study involving patients with biopsy-confirmed nodal metastases and a placed clip in the sampled node.
• Post-neoadjuvant therapy, patients underwent axillary surgery, comparing clipped node pathology with other nodes.
• Targeted axillary dissection (TAD) involved SLND and selective removal of the clipped node using iodine-125 seed localization.
• False-negative rates were calculated in patients undergoing complete axillary lymphadenectomy (ALND).

Main Results:

• Of 191 patients undergoing ALND, 120 (63%) had residual disease. The clipped node identified metastases in 115 patients (FNR 4.2%).
• In patients undergoing SLND and ALND (n=118), the FNR was 10.1%. Incorporating clipped node evaluation reduced the FNR to 1.4% (P=.03).
• The clipped node was not retrieved as an SLN in 23% of patients, highlighting its importance for targeted removal. TAD followed by ALND yielded an FNR of 2.0%.

Conclusions:

• Marking biopsy-confirmed metastatic nodes with clips enables selective removal and enhances pathologic assessment of residual nodal disease post-chemotherapy.
• Targeted axillary dissection, including evaluation of clipped nodes, significantly lowers the false-negative rate in breast cancer nodal staging.
• Clip placement is a valuable tool for improving the accuracy of axillary staging after neoadjuvant therapy.