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

Autor: Cabıoğlu N; Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye. neslicab@yahoo.com., Karanlık H; Department of Surgical Oncology, Istanbul University, Institute of Oncology, Istanbul, Türkiye., Yılmaz R; Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye., Emiroğlu S; Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye., Tükenmez M; Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye., Bademler S; Department of Surgical Oncology, Istanbul University, Institute of Oncology, Istanbul, Türkiye., Şimşek DH; Department of Nuclear Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye., Kantarcı TR; Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye., Yirgin İK; Department of Radiology, Istanbul University, Institute of Oncology, Istanbul, Türkiye., Bayram A; Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye., Dursun M; Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye.
Jazyk: angličtina
Zdroj: World journal of surgical oncology [World J Surg Oncol] 2024 Jul 06; Vol. 22 (1), pp. 178. Date of Electronic Publication: 2024 Jul 06.
DOI: 10.1186/s12957-024-03413-6
Abstrakt: 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.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje