Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jun 7;16(12):2172.
doi: 10.3390/cancers16122172.

Wire-Free Targeted Axillary Dissection: A Pooled Analysis of 1300+ Cases Post-Neoadjuvant Systemic Therapy in Node-Positive Early Breast Cancer

Jajini Varghese  1   2   3 , Neill Patani  1   3 , Umar Wazir  1 , Shonnelly Novintan  1   4 , Michael J Michell  1   5 , Anmol Malhotra  1   2   3 , Kinan Mokbel  1   6 , Kefah Mokbel  1
Affiliations
Review

Wire-Free Targeted Axillary Dissection: A Pooled Analysis of 1300+ Cases Post-Neoadjuvant Systemic Therapy in Node-Positive Early Breast Cancer

Jajini Varghese et al. Cancers (Basel). .

Abstract

Recent advances in neoadjuvant systemic therapy (NST) have significantly improved pathologic complete response rates in early breast cancer, challenging the role of axillary lymph node dissection in nose-positive patients. Targeted axillary dissection (TAD) integrates marked lymph node biopsy (MLNB) and tracer-guided sentinel lymph node biopsy (SLNB). The introduction of new wire-free localisation markers (LMs) has streamlined TAD and increased its adoption. The primary endpoints include the successful localisation and retrieval rates of LMs. The secondary endpoints include the pathological complete response (pCR), SLNB, and MLNB concordance, as well as false-negative rates. Seventeen studies encompassing 1358 TAD procedures in 1355 met the inclusion criteria. The localisation and retrieval rate of LMs were 97% and 99%. A concordance rate of 67% (95% CI: 64-70) between SLNB and MLNB was demonstrated. Notably, 49 days (range: 0-272) was the average LM deployment time to surgery. pCR was observed in 46% (95% CI: 43-49) of cases, with no significant procedure-related complications. Omitting MLNB or SLNB would have under-staged the axilla in 15.2% or 5.4% (p = 0.0001) of cases, respectively. MLNB inclusion in axillary staging post-NST for initially node-positive patients is crucial. The radiation-free Savi Scout, with its minimal MRI artefacts, is the preferred technology for TAD.

Keywords: breast cancer; node positive; systematic review; targeted axillary dissection.

PubMed Disclaimer

Conflict of interest statement

Kefah Mokbel has received honoraria for offering academic and clinical advice to Merit Medical, Q Medical, and Sebbin corporations. Other authors declare no conflicts of interest. Merit Medical had no role in the design of this study, the collection and interpretation of data, or the decision to proceed with the publication.

Figures

Figure 1
Figure 1
Successful localisation of localisation markers [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29].
Figure 2
Figure 2
Successful retrieval of localisation markers [13,14,15,16,17,19,20,21,22,23,24,25,26,27,29].
Figure 3
Figure 3
Pathological complete response [13,14,15,16,17,19,20,22,23,24,25,26,27,29].
See this image and copyright information in PMC

References

    1. Bakri N.A.C., Kwasnicki R.M., Khan N., Ghandour O., Lee A., Grant Y., Dawidziuk A., Darzi A., Ashrafian H., Leff D.R. Impact of Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy on Upper Limb Morbidity in Breast Cancer Patients a Systematic Review and Meta-Analysis. Ann. Surg. 2023;277:572–580. doi: 10.1097/SLA.0000000000005671. - DOI - PMC - PubMed
    1. Geng C., Chen X., Pan X., Li J. The Feasibility and Accuracy of Sentinel Lymph Node Biopsy in Initially Clinically Node-Negative Breast Cancer after Neoadjuvant Chemotherapy: A Systematic Review and Meta-Analysis. PLoS ONE. 2016;11:e0162605. doi: 10.1371/journal.pone.0162605. - DOI - PMC - PubMed
    1. Bartels S.A., Donker M., Poncet C., Sauvé N., Straver M.E., van de Velde C.J., Mansel R.E., Blanken C., Orzalesi L., Klinkenbijl J.H., et al. Radiotherapy or Surgery of the Axilla After a Positive Sentinel Node in Breast Cancer: 10-Year Results of the Randomized Controlled EORTC 10981-22023 AMAROS Trial. J. Clin. Oncol. 2023;41:2159–2165. doi: 10.1200/jco.22.01565. - DOI - PubMed
    1. Giuliano A.E., Ballman K.V., McCall L., Beitsch P.D., Brennan M.B., Kelemen P.R., Ollila D.W., Hansen N.M., Whitworth P.W., Blumencranz P.W., et al. Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival among Women with Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017;318:918–926. doi: 10.1001/jama.2017.11470. - DOI - PMC - PubMed
    1. Chehade H.E.H., Headon H., El Tokhy O., Heeney J., Kasem A., Mokbel K. Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients. Am. J. Surg. 2016;212:969–981. doi: 10.1016/j.amjsurg.2016.07.018. - DOI - PubMed