Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
EPIUnit-Institute of Public Health, University of Porto, Rua das Taipas, 135, 4050-598, Porto, Portugal.
Breast Cancer. 2022 Jul;29(4):709-719. doi: 10.1007/s12282-022-01349-x. Epub 2022 Mar 19.
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.
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).
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.
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.
靶向腋窝清扫术（TAD）结合前哨淋巴结活检（SNB）和先前标记的转移性淋巴结切除。TAD 是一种有前途的概念，适用于新辅助治疗（NAT）后病理完全缓解（pCR）的淋巴结阳性乳腺癌患者的腋窝分期。我们旨在评估这一背景下 TAD 的可行性。
在经活检证实的 cN1 患者中进行了一项前瞻性观察性研究。夹闭的淋巴结（CN）的切除由术中超声引导。SNB 使用吲哚菁绿和专利蓝 V 染料。如果 CN 或前哨淋巴结（SLN）有任何转移灶，或者 TAD 程序不成功，患者将接受腋窝淋巴结清扫术（ALND）。
共纳入 37 例患者。TAD 和 SNB 识别率分别为 97.3%。每一个回收的 CN 也是一个 SLN。在个体水平上，使用吲哚菁绿 SNB 识别率为 89.2%，使用专利蓝 V 染料为 85.5%。CN 的识别率为 81.1%，当 CN 在术中超声上定位时更高（84.4%比 60.0%）。我们的患者中有 54.1%达到了淋巴结 pCR，HER2 阳性和三阴性肿瘤更为常见（p=0.039）。19 例患者免于 ALND。
术中超声引导切除 CN 和 SNB 联合使用吲哚菁绿和专利蓝 V 染料的 TAD 是一种可行的概念，可以识别出 NAT 后无腋窝残留疾病的患者，从而避免 ALND，尽管需要进一步研究标记活检淋巴结的必要性。
