Wire-Free Targeted Axillary Dissection: A Pooled Analysis of 1300+ Cases Post-Neoadjuvant Systemic Therapy in...

Area of Science:

• Oncology
• Surgical Oncology
• Radiology

Background:

• Neoadjuvant systemic therapy (NST) improves outcomes in early breast cancer, necessitating re-evaluation of axillary lymph node dissection.
• Targeted axillary dissection (TAD) combines marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB) for axillary staging.

Purpose of the Study:

• To evaluate the efficacy and safety of TAD integrating new wire-free localization markers (LMs) for axillary staging in early breast cancer patients post-NST.
• To assess the performance of TAD in terms of localization and retrieval rates, concordance, and impact on staging accuracy.

Main Methods:

• Systematic review and meta-analysis of 17 studies involving 1358 TAD procedures in 1355 patients.
• Analysis of primary endpoints: LM localization and retrieval rates.
• Analysis of secondary endpoints: pathologic complete response (pCR), SLNB/MLNB concordance, false-negative rates, and procedure-related complications.

Main Results:

• High LM localization (97%) and retrieval (99%) rates were achieved.
• A concordance rate of 67% between SLNB and MLNB was observed.
• Omitting MLNB or SLNB would have led to under-staging in 15.2% or 5.4% of cases, respectively (p=0.0001).
• Pathologic complete response (pCR) was 46%, with no significant complications. Savi Scout was identified as preferred technology.

Conclusions:

• MLNB is essential for accurate axillary staging in node-positive breast cancer patients following NST.
• TAD, particularly with wire-free LMs like Savi Scout, offers a safe and effective approach to axillary staging.
• The integration of MLNB into TAD improves staging accuracy and challenges the routine use of axillary lymph node dissection.