Major Reduction in Axillary Lymph Node Dissections After Neoadjuvant Systemic Therapy for Node-Positive Breast Cancer...

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Background:

• Axillary lymph node dissection (ALND) is a standard procedure for node-positive (cN+) breast cancer.
• Neoadjuvant systemic therapy (NST) is increasingly used to treat breast cancer.
• Minimizing unnecessary surgical procedures like ALND is a key goal in breast cancer management.

Purpose of the Study:

• To evaluate the effectiveness of a combined imaging and marking strategy to avoid ALND in cN+ breast cancer patients after NST.
• To present the implementation results of a tailored axillary treatment protocol based on PET/CT and MARI procedures.

Main Methods:

• A retrospective analysis of 159 node-positive breast cancer patients treated with NST from July 2014 to July 2017.
• Patients underwent positron emission tomography/computed tomography (PET/CT) before NST and the MARI (marking axillary lymph nodes with radioactive iodine seeds) procedure after NST.
• Axillary treatment was tailored based on combined PET/CT and MARI results, including omission of ALND, locoregional radiotherapy, or ALND.

Main Results:

• ALND was successfully omitted in 130 patients (82%).
• Of the 159 patients, 91 (57%) received locoregional radiotherapy, and 39 (25%) had no further axillary treatment.
• The strategy demonstrated a high rate of successful ALND avoidance.

Conclusions:

• The combined approach of pre-NST PET/CT and post-NST MARI staging significantly reduces ALND rates in cN+ breast cancer patients.
• This strategy allows for tailored axillary treatment, potentially improving patient outcomes and reducing surgical morbidity.
• The findings support the implementation of this combined imaging and marking strategy in clinical practice.