Initial Insights into Targeted Axillary Dissection Post-Neoadjuvant Therapy in Node-Positive Breast Cancer: A Pilot Interventional Study.

Abstract

Background: The most commonly detected malignancy and the second most prevalent cause of cancer-related death in women globally is breast cancer. The treatment of breast cancer is significantly influen-ced by the accurate staging and proper management of axillary lymph nodes (ALNs). The surgical management of the axilla in breast cancer has undergone a significant transformation over the past two decades. The routine axillary lymph nodes (LN) dissection, which is associated with a higher level of morbidity in early-stage node-negative patients, has been replaced by sentinel LN biopsy (SLNB), which was initially investigated in the early nineties. SLNB offers precise evaluations of nodal status and essential staging data.

Objective: To determine the accuracy of targeted axillary resection and ensuring surgical removal of clipped nodes would improve accuracy of nodal staging in those patients.

Patients and methods: This Pilot Interventional study was conducted at Al Demerdash Hospital, Faculty of Medicine, Ain Shams University, between March 2020 and March 2021. The institutional research and ethics committee reviewed and approved the study protocol. Thirty patients with clinical node-positive breast cancer who were undergoing neo-adjuvant chemotherapy (NACT) were involved in the study.

Results: In all, 24 patients with clipped ALNs were stained with patent blue dye and five patients with clipped ALNs were not stained by patent blue dye. Therefore, SLNB was unable to detect five clipped ALNs in five patients, so there is a false-negative rate (FNR) of 17.2%. Therefore, with the targeted procedure we can decrease the FNR of sentinel nodes.

Conclusion: Targeted axillary dissection is a feasible technique for axillary management in clinically N1 breast cancer patients who receive NACT and turned to N0. Preoperative clipped node guide wire localization significantly enhances the identification clipped node rate and decreases the FNR of SLNB alone.