Targeted axillary dissection after neoadjuvant systemic therapy in patients with node-positive breast cancer

This article was first published by the Royal Australasian College of Surgeons in November 2019.


Background: Over the last decade, neoadjuvant systemic therapy (NAST) has gained considerable popularity and its use has been extended to include breast cancer patients with operable node-positive disease. It may no longer be necessary to commit patients who are node-positive at presentation to axillary dissection if they become clinically node-negative after completing NAST. Targeted axillary dissection (TAD) is a technique where the marked pre-NAST positive node is excised along with the sentinel nodes and its response to chemotherapy is assessed and thus helps guide further treatment to the axilla.

Methods: The aim of this study was to determine the feasibility of marking positive axillary nodes with a clip and removing the clipped node after neoadjuvant treatment. We also assessed the concordance of the sentinel node with the clipped node.

Results: We prospectively evaluated 37 clinically and/or radiologically node-positive patients who underwent NAST. The overall identification rate of the clipped node was 78%. The identification rate was 100% if the clipped node was localized preoperatively and was much lower at 68% in patients who did not have the clipped node localized. The clipped node was not retrieved as the sentinel node in 14% of patients.

Conclusion: We present the first Australian series on the feasibility of TAD. TAD is a feasible option in patients having NAST and with every new technique there is a learning curve. With the increasing experience globally and the refinement in marking and localization techniques, the accuracy of performing TAD will likely continue to improve.


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