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. 2023 Oct;30(11):6361-6369.
doi: 10.1245/s10434-023-13792-x. Epub 2023 Jul 3.

Comparing Methods for Targeted Axillary Dissection in Breast Cancer Patients: A Nationwide, Retrospective Study

Frederikke Munck  1 , Pernille Jepsen  2 , Pernille Zeuthen  3 , Lena Carstensen  4 , Katrine Hauerslev  5 , Christian K Paaskesen  6 , Inge S Andersen  7 , Ute Høyer  8 , Charlotte Lanng  9 , Maria K Gerlach  10 , Ilse Vejborg  11 , Niels T Kroman  9 , Tove H F Tvedskov  9
Affiliations

Comparing Methods for Targeted Axillary Dissection in Breast Cancer Patients: A Nationwide, Retrospective Study

Frederikke Munck et al. Ann Surg Oncol. 2023 Oct.

Abstract

Background: Several techniques exist for performing targeted axillary dissection (TAD) after neoadjuvant chemotherapy with the removal of the sentinel node and a marked metastatic lymph node (LN). Two-step methods include coil-marking of the metastatic LN at diagnosis and re-marking with an intraoperatively identifiable marker before surgery. Because nondetection of the marked lymph node (MLN) warrants axillary clearance and many patients achieve axillary pathological complete response (ax-pCR), the success of TAD is crucial. We compare various two-step TAD methods in a Danish national cohort.

Methods: We included patients who received two-step TAD between January 1, 2016 and August 31, 2021. Patients were identified from the Danish Breast Cancer Group database and cross-checked with locally accessible lists. Data were extracted from the patient's medical files.

Results: We included 543 patients. In 79.4%, preoperative, ultrasound-guided re-marking was possible. Nonidentification of the coil-marked LN was more likely in patients with ax-pCR. The second markers used were hook-wire, iodine seeds, or ink marking on the axillary skin. Of patients with successful secondary marking, the MLN identification rate (IR) was 91%, and the sentinel node (SN) IR was 95%. Marking with iodine seeds was significantly more successful than ink marking with an odds ratio of 5.34 (95% confidence interval 1.62-17.60). The success rate of the complete TAD with the removal of MLN and SN was 82.3%.

Conclusions: With two-step TAD, nonidentification of the coiled LN before surgery is frequent, especially in patients with ax-pCR. Despite successful remarking, the IR of the MLN at surgery is inferior to one-step TAD.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Patient flow and outcomes among Danish breast cancer patients receiving targeted axillary dissection after neoadjuvant chemotherapy
See this image and copyright information in PMC

Comment in

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