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Single-port Non-liposuction Endoscopic Axillary Lymph Node Dissection in Breast Cancer Surgery
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Biologic and morphologic determinants of post-neoadjuvant ultrasound detectability of clipped axillary lymph nodes in
Mehmet Ali Nazlı1, Emel Esmerer2
1Department of Radiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.
Background:
Targeted axillary dissection (TAD) has emerged as an alternative to routine axillary lymph node dissection in selected node-positive breast cancer patients treated with neoadjuvant chemotherapy (NACT). Reliable localization of the clip-marked metastatic lymph node is essential for this approach. However, determinants of post-NACT ultrasound detectability remain incompletely characterized.
Methods:
This retrospective single-center study included 111 patients with biopsy-proven node-positive breast cancer who underwent ultrasound-guided clip placement in metastatic axillary lymph nodes prior to NACT. Post-treatment axillary ultrasound was performed before surgery to assess clip visibility. Radiologic, anatomic, and molecular factors associated with detectability were analyzed using univariate and multivariate models. Alternative localization techniques were applied when ultrasound identification was unsuccessful.
Results:
Ultrasound successfully localized the clipped node in 85.6% of patients. Radiologic complete nodal response was the strongest predictor of clip invisibility (63.4% vs. 98.6% visibility in nodes with residual features, p < 0.001). HER2-positive subtype were associated with lower detectability compared with luminal HER2-negative subtypes (64.7% vs. 89.3%, p = 0.020), likely reflecting higher rates of treatment-induced nodal response rather than a direct imaging-related effect. Tumor size, lymph node size, and skin-to-node distance were not associated with ultrasound visibility. CT-guided localization was feasible in cases where ultrasound failed. Axillary recurrence occurred in 1.8% of patients after a median follow-up of 36 months, exclusively in those with residual nodal disease.
Conclusion:
Post-NACT ultrasound detectability of clipped axillary lymph nodes is primarily influenced by treatment-induced nodal response rather than static anatomic factors. In biologic subgroups with a high likelihood of complete nodal response, ultrasound invisibility may be anticipated as a consequence of therapeutic effect. These findings may provide preliminary insights relevant to preoperative risk awareness and localization planning; however, no predictive decision model was developed, and prospective validation is required.
