Targeted axillary dissection in breast cancer patients with metastatic nodal disease: a prospective study on localization techniques and oncological outcomes.

Abstract

Background: Neoadjuvant chemotherapy followed by targeted axillary dissection (TAD) has been proposed as an alternative to axillary lymph node dissection (ALND) in breast cancer patients with metastatic nodal disease. However, there is lack of standardization of TAD technique. This study aimed to prospectively evaluate the effectiveness of various localization techniques in TAD and assess the oncological outcomes of TAD alone versus ALND.

Methods: Breast cancer patients with histologically proven nodal metastasis (T1-4N1-2M0) and neoadjuvant chemotherapy were included. Patients were divided into three groups: TAD-alone, TAD with ALND, and upfront ALND. Localization techniques used during TAD were assessed and oncological outcomes were compared between the TAD alone and ALND groups. This study was registered with ClinicalTrials.gov (identifier: NCT03878017).

Results: One hundred and twenty-three patients, of which 18, 18, 87 underwent TAD alone, TAD with ALND and upfront ALND respectively, were included. All localization techniques, such as skin marking, Savi Scout and radio-guided occult lesion localization (ROLL) resulted in 100% retrieval of the marked node. Single-agent sentinel node localization during TAD was feasible. After a median follow-up of 13 and 23 months for the TAD-alone and ALND groups respectively, there were no significant differences in their oncological outcomes.

Conclusions: Various localization techniques, including the less studied skin marking and ROLL, were effective in TAD. During TAD, single agent may be used for sentinel node localization. TAD alone did not have inferior oncologic outcomes on short term follow-up and may replace ALND in patients with complete nodal pathological response after neoadjuvant chemotherapy. Our findings need validation in larger studies with longer follow-up.