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- Title
Wire-Free Targeted Axillary Dissection: A Pooled Analysis of 1300+ Cases Post-Neoadjuvant Systemic Therapy in Node-Positive Early Breast Cancer.
- Authors
Varghese, Jajini; Patani, Neill; Wazir, Umar; Novintan, Shonnelly; Michell, Michael J.; Malhotra, Anmol; Mokbel, Kinan; Mokbel, Kefah
- Abstract
Simple Summary: Preoperative chemotherapy significantly improves response rates in early breast cancer, challenging the traditional approach of invasive axillary surgery in patients presenting with node-positive disease. Wire-free localisation markers can successfully mark lymph nodes at diagnosis. Our findings demonstrate that these markers are successfully utilised, localised, and retrieved intraoperatively. Incorporating preoperative lymph node marking into the current biopsy procedure allows for more accurate staging of the axilla whilst reducing the need for invasive axillary surgery. These findings underscore the importance of incorporating both types of biopsies in axillary staging following preoperative chemotherapy for initially node-positive patients. 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.
- Subjects
SENTINEL lymph node biopsy; PATIENT safety; BREAST tumors; AXILLARY lymph node dissection; PATHOLOGIC complete response; CHI-squared test; DESCRIPTIVE statistics; CANCER patients; SYSTEMATIC reviews; MEDLINE; COMBINED modality therapy; QUALITY of life; ONLINE information services; CONFIDENCE intervals; DATA analysis software; DISEASE incidence; OVERALL survival
- Publication
Cancers, 2024, Vol 16, Issue 12, p2172
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16122172