Introduction
Advancements in axillary surgery for breast cancer have improved outcomes, particularly for patients with clinically positive lymph nodes (N1) who achieve nodal downstaging after neoadjuvant chemotherapy (NACT). However, sentinel lymph node biopsy (SLNB) in this setting has a high false-negative rate (FNR). Targeted axillary dissection (TAD), which includes removal of a biopsy-confirmed clipped lymph node alongside SLNB, has been proposed to improve accuracy.
Objectives
To evaluate the accuracy of TAD in detecting residual nodal disease post-NACT and its impact on reducing the FNR of SLNB.
Patients and Methods
This prospective study included 30 N1 breast cancer patients who became clinically and radiologically node-negative (N0) after NACT. All underwent TAD, involving SLNB combined with removal of the previously clipped metastatic node.
Results
Among 29 evaluated patients, two had residual disease in the clipped lymph node on frozen section, with one also showing a positive SLN. Axillary lymph node dissection (ALND) was performed in all cases, confirming no further residual disease. Clipped ALNs were identified by patent blue dye in 24 patients, while five were unstained, resulting in a 17.2% FNR for SLNB alone. TAD successfully removed all previously positive nodes, thereby reducing the FNR and improving nodal assessment.
Conclusion
TAD enhances the accuracy of axillary staging post-NACT by ensuring removal of
initially positive nodes, reducing the FNR of SLNB alone, and providing a more
reliable assessment of treatment response.
Authors
AHMED AOSMALI
King's College Hospital NHS Trust, LONDON, Egypt
Momen Abdelglil
Faculty of Medicine Mansure University, Mansura, Egypt
Madhu Srinivasan (Presenting)
King's College Hospital NHS Trust, LONDON, Egypt
Rodaina Radwan
AIN SHAMS UNIVERSITY FACULTY OF MEDICINE, CAIRO, Egypt
Mahmoud Nafie
King's College Hospital NHS Trust, LONDON, United Kingdom
AMIRA MAHER
AIN SHAMS UNIVERSITY FACULTY OF MEDICINE, CAIRO, Egypt