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Initial experience with targeted axillary dissection after neoadjuvant therapy in breast cancer patients

Pinto, C. S. ; Peleteiro, B. ; Pinto, C. A. ; Osório, F. ; Costa, S. ; Magalhães, A. ; Mora, H. ; Amaral, J. ; Gonçalves, D. ; Fougo, J. L.

Breast cancer (Tokyo, Japan), 2022-07, Vol.29 (4), p.709-719 [Periódico revisado por pares]

Singapore: Springer Nature Singapore

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  • Título:
    Initial experience with targeted axillary dissection after neoadjuvant therapy in breast cancer patients
  • Autor: Pinto, C. S. ; Peleteiro, B. ; Pinto, C. A. ; Osório, F. ; Costa, S. ; Magalhães, A. ; Mora, H. ; Amaral, J. ; Gonçalves, D. ; Fougo, J. L.
  • Assuntos: Cancer Research ; Medicine ; Medicine & Public Health ; Oncology ; Original ; Original Article ; Surgery ; Surgical Oncology
  • É parte de: Breast cancer (Tokyo, Japan), 2022-07, Vol.29 (4), p.709-719
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
    ObjectType-Undefined-3
  • Descrição: Background Targeted axillary dissection (TAD) combines sentinel node biopsy (SNB) with the removal of the previously marked metastatic node. TAD is a promising concept for axillary restaging in node-positive breast cancer patients with pathological complete response (pCR) to neoadjuvant therapy (NAT). We aimed to evaluate TAD feasibility in this context. Methods A prospective observational study was conducted in biopsy-confirmed cN1 patients. The removal of the clipped node (CN) was guided by intraoperative ultrasound. SNB used indocyanine green and patent blue V dye. If the CN or sentinel lymph nodes (SLN) had any metastatic foci, or the TAD procedure was unsuccessful, the patient underwent axillary lymph node dissection (ALND). Results Thirty-seven patients were included. TAD and SNB identification rates were 97.3%. Every retrieved CN was also a SLN. At the individual level, SNB identification rate was 89.2% with indocyanine green and 85.5% with patent blue V dye. The CN identification rate was 81.1%, being higher when the CN was localized on the intraoperative ultrasound (84.4% vs 60.0%). Nodal pCR was achieved by 54.1% of our patients and was more frequent in HER2-positive and triple-negative tumors ( p  = 0.039). Nineteen patients were spared from ALND. Conclusion TAD with intraoperative ultrasound-guided excision of the CN and SNB with indocyanine green and patent blue V dye is a feasible concept to identify patients without axillary residual disease after NAT, that can be spared from ALND, although the need for marking the biopsied node should be further investigated.
  • Editor: Singapore: Springer Nature Singapore
  • Idioma: Inglês
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