NDLI: Targeted axillary dissection reduces residual nodal disease in clinically node- positive breast cancer after neoadjuvant chemotherapy

Content Provider	Springer Nature : BioMed Central
Author	Cabıoğlu, Neslihan Karanlık, Hasan Yılmaz, Ravza Emiroğlu, Selman Tükenmez, Mustafa Bademler, Süleyman Şimşek, Duygu Has Kantarcı, Tarık Recep Yirgin, İnci Kızıldağ Bayram, Aysel Dursun, Memduh
Abstract	Background Any advantage of performing targeted axillary dissection (TAD) compared to sentinel lymph node (SLN) biopsy (SLNB) is under debate in clinically node-positive (cN+) patients diagnosed with breast cancer. Our objective was to assess the feasibility of the removal of the clipped node (RCN) with TAD or without imaging-guided localisation by SLNB to reduce the residual axillary disease in completion axillary lymph node dissection (cALND) in cN+ breast cancer. Methods A combined analysis of two prospective cohorts, including 253 patients who underwent SLNB with/without TAD and with/without ALND following NAC, was performed. Finally, 222 patients (cT1-3N1/ycN0M0) with a clipped lymph node that was radiologically visible were analyzed. Results Overall, the clipped node was successfully identified in 246 patients (97.2%) by imaging. Of 222 patients, the clipped lymph nodes were non-SLNs in 44 patients (19.8%). Of patients in cohort B (n=129) with TAD, the clipped node was successfully removed by preoperative image-guided localisation, or the clipped lymph node was removed as the SLN as detected on preoperative SPECT-CT. Among patients with ypSLN(+) (n=109), no significant difference was found in non-SLN positivity at cALND between patients with TAD and RCN (41.7% vs. 46.9%, p=0.581). In the subgroup with TAD with axillary lymph node dissection (ALND; n=60), however, patients with a lymph node (LN) ratio (LNR) less than 50% and one metastatic LN in the TAD specimen were found to have significantly decreased non-SLN positivity compared to others (27.6% vs. 54.8%, p=0.032, and 22.2% vs. 50%, p=0.046). Conclusions TAD by imaging-guided localisation is feasible with excellent identification rates of the clipped node. This approach has also been found to reduce the additional non-SLN positivity rate to encourage omitting ALND in patients with a low metastatic burden undergoing TAD.
Related Links	https://wjso.biomedcentral.com/counter/pdf/10.1186/s12957-024-03413-6.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	14777819
DOI	10.1186/s12957-024-03413-6
Journal	World Journal of Surgical Oncology
Issue Number	1
Volume Number	22
Language	English
Publisher	BioMed Central
Publisher Date	2024-07-06
Access Restriction	Open
Subject Keyword	Surgical Oncology Sentinel lymph node biopsy Neoadjuvant chemotherapy Targeted axillary dissection Clipped node Wire-localisation Radio-guided occult lesion localisation (ROLL) CT-guided localisation Residual nodal disease
Content Type	Text
Resource Type	Article
Subject	Oncology Surgery
Journal Impact Factor	2.5/2023
5-Year Journal Impact Factor	2.8/2023

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