Initial Insights into Targeted Axillary Dissection Post-Neoadjuvant Therapy in Node-Positive Breast Cancer: A Pilot...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Breast cancer is a leading global malignancy and cause of cancer death in women.
• Accurate axillary lymph node (ALN) staging is crucial for breast cancer treatment.
• Sentinel lymph node biopsy (SLNB) has largely replaced axillary lymph node dissection for early-stage patients.

Purpose of the Study:

• To evaluate the accuracy of targeted axillary resection in breast cancer patients.
• To determine if preoperative clipping and targeted removal of ALNs improve nodal staging accuracy.

Main Methods:

• A pilot interventional study involving 30 patients with clinical node-positive breast cancer undergoing neoadjuvant chemotherapy (NACT).
• Preoperative clipping of axillary lymph nodes followed by sentinel lymph node biopsy (SLNB).

Main Results:

• Of 30 patients, 24 had clipped ALNs successfully stained with patent blue dye.
• SLNB failed to detect clipped ALNs in 5 patients, resulting in a 17.2% false-negative rate (FNR).
• Targeted axillary dissection demonstrated potential to decrease the FNR of SLNB.

Conclusions:

• Targeted axillary dissection is a viable approach for managing clinically N1 breast cancer patients who become node-negative (N0) after NACT.
• Preoperative guide wire localization of clipped nodes significantly improves identification rates and reduces the FNR of SLNB.