[Can we avoid axillary lymph node dissection in patients with node positive invasive breast carcinoma?]

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Management

Context:

• Breast and axillary surgery practices are evolving towards personalized treatment and reduced overtreatment.
• The Senology Commission of the Collège National des Gynécologues et Obstétriciens Français (CNGOF) addressed key questions on axillary surgery updates.

Purpose:

• To define and evaluate targeted axillary dissection (TAD) techniques.
• To assess the feasibility of surgical de-escalation in initial lymph node involvement and post-neoadjuvant systemic therapy (NAST).
• To identify contraindications for axillary de-escalation concerning adjuvant therapies.

Summary:

• Targeted axillary dissection (TAD) combines excision of clipped metastatic nodes and axillary sentinel lymph nodes (ASLNs), improving detection rates but requiring standardization.
• TAD is a viable alternative to axillary clearance for single resectable metastatic nodes.
• Current French guidelines do not recommend TAD or ASLN alone post-NAST outside clinical trials, though international practices vary.

Impact:

• Axillary de-escalation, including TAD, can significantly reduce the morbidity associated with axillary clearance.
• TAD is poised to replace axillary clearance for specific indications, provided method standardization and clear guidelines are established.
• Defining TAD's role is crucial for optimizing access to novel adjuvant targeted therapies in breast cancer.