Department of Surgical Oncology, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12], Universidad Complutense de Madrid, Madrid, Spain.
Department of Medical Oncology, University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12], Universidad Complutense de Madrid, Madrid, Spain.
Surg Oncol. 2022 Sep;44:101823. doi: 10.1016/j.suronc.2022.101823. Epub 2022 Aug 2.
Targeted axillary dissection, which combines sentinel lymph node biopsy with removal of the proven involved node noted during the staging process, has been shown to improve axillary staging and decrease false negative rates after neoadjuvant chemotherapy in patients with breast cancer.
OBJECTIVE(S): The main goal of this study was to assess the ability to identify and remove the clipped node and the false negative rate of targeted axillary dissection.
We performed a prospective study among patients with biopsy-confirmed nodal metastases who received neoadjuvant chemotherapy. A clip was placed on the sample node prior systemic therapy. After neoadjuvant chemotherapy, all patients underwent sentinel lymph node biopsy (dual tracer), localization and excision of the clipped node and axillary lymph node dissection. The clipped node was preoperatively localized in all cases placing an iodine-125 seed guided by ultrasound. The pathology of the sentinel nodes and clipped node was compared with other nodes.
A total of 455 patients with invasive breast cancer were studied. Of the 148 patients with NAC, 32 met the eligibility criteria and were enrolled in the study. Mean age at diagnosis was 52.3 years. Systematic lymphadenectomy was performed in all patients, with an average of 14.3 lymph nodes removed. Detection rate of the clipped node alone was 96.9%, and 100% for targeted axillary dissection. Ability of clipped node alone to predict nodal status showed a FNR of 10,5% while SLNB alone performed by dual tracer and targeted axillary dissection, showed FNRs of 5.3% and 5.0%, respectively. Sentinel lymph nodes matched clipped node in 23 patients (74.2%).
CONCLUSION (S): In node positive breast cancer patients, targeted axillary dissection is a reliably approach for axillary staging after neoadjuvant chemotherapy. The preoperative location of the clipped node is mandatory to increase the detection rate and optimize the results of the technique.
靶向腋窝清扫术结合前哨淋巴结活检术和分期过程中发现的阳性淋巴结切除，已被证明可以改善乳腺癌患者的腋窝分期并降低新辅助化疗后的假阴性率。
本研究的主要目的是评估识别和切除夹闭淋巴结的能力以及靶向腋窝清扫术的假阴性率。
我们对接受新辅助化疗的活检证实淋巴结转移的患者进行了一项前瞻性研究。在系统治疗前，在样本淋巴结上放置一个夹子。新辅助化疗后，所有患者均行前哨淋巴结活检（双示踪剂）、夹闭淋巴结的定位和切除以及腋窝淋巴结清扫。所有病例均通过超声引导放置碘 125 种子来术前定位夹闭淋巴结。比较前哨淋巴结和夹闭淋巴结的病理与其他淋巴结。
共研究了 455 例浸润性乳腺癌患者。在 148 例接受 NAC 的患者中，32 例符合入选标准并被纳入研究。诊断时的平均年龄为 52.3 岁。所有患者均行系统性淋巴结清扫术，平均切除 14.3 个淋巴结。单独检测夹闭淋巴结的检出率为 96.9%，靶向腋窝清扫术的检出率为 100%。单独夹闭淋巴结预测淋巴结状态的能力显示假阴性率为 10.5%，而双示踪剂前哨淋巴结活检和靶向腋窝清扫术的假阴性率分别为 5.3%和 5.0%。23 例（74.2%）前哨淋巴结与夹闭淋巴结匹配。
在淋巴结阳性乳腺癌患者中，新辅助化疗后靶向腋窝清扫术是一种可靠的腋窝分期方法。术前定位夹闭淋巴结是提高检出率和优化该技术结果的必要条件。
