Targeted axillary dissection using CT-Lymphography and the tattooing technique after neoadjuvant chemotherapy for...

Targeted axillary dissection (TAD) has been introduced to improve axillary staging accuracy after neoadjuvant chemotherapy (NAC) in patients with node-positive breast cancer; however, reliable localization of the clipped lymph node (clipLN) remains technically challenging, particularly in cases with discordance between sentinel lymph node (SLN) and clipLN. We retrospectively reviewed a single-institution case series of patients with node-positive breast cancer who underwent TAD after NAC. CT-lymphography (CT-LG) was used for preoperative assessment of lymphatic anatomy, and the tattooing technique was applied for intraoperative localization of the clipLN. A total of 12 patients were included. SLN-clipLN discordance was frequently observed on CT-LG, including among ypN0 cases. ClipLN retrieval was successful in all patients who underwent the tattooing-assisted procedure. The combination of CT-LG and the tattooing technique facilitated intraoperative identification of clipLN, even in anatomically discordant cases. In this single-institution experience, TAD using CT-LG and the tattooing technique was technically feasible for clipLN localization after NAC. CT-LG aided preoperative recognition of anatomical discordance, while tattooing contributed to reproducible intraoperative localization. This experience reflects an initial implementation phase of TAD, and further studies are warranted to define optimal localization strategies for axillary management after NAC.