Evaluation of Targeted Axillary Dissection Following Neoadjuvant Therapy for A Patient with Node-positive Breast Cancer as Initial Experience in Ain Shams University Hospitals

Abstract

Surgical treatment of the axilla in breast cancer shows a lot of advances over the past decade. Patients with clinical positive LN have a great chance to turn by neo-adjuvant chemotherapy to be negative clinically and radiologically and so surgical management in those patients is still a field of research. Sentinel LN biopsy in such patients showed high false negative rate which was decreased by the use of immunohistochemistry (IHC) and if a clip was placed in the node with biopsy-confirmed metastases, with removal of that node with the SLNB which is called targeted axillary dissection (TAD) our objective was To determine the accuracy of TAD and ensuring surgical removal of clipped nodes would improve accuracy of nodal staging in patients with initiall positive LN a prospective study including thirty patients with cT1_3(a-c) cN1-2, M0 breast cancer post NACT who had shown down staging of their nodal status (N0) as proven by clinical examination and ultrasound assessment who were recommended for targeted axillary dissection removing the clipped LN added to the SLNB at Ain Shams University Hospital, between March 2020 and March 2021. We found that Out of the 29 patients, 2 patients showed residual disease in the clipped LN in frozen section, one of them revealed positive SLN as well. Completion of axillary LN dissection was done regardless of frozen section results to detect any residual nodal disease which reveled negative results in all cases and that indicate the success of TAD in removing the diseased LN and decreasing the false negative rate of SLN alone. 24 Patients with clipped axillary LNs were stained with patent blue dye while 5 patients with clipped axillary LNs were not stained by patent blue dye. Therefore SLN was unable to detect clipped axillary LNs which were previously positive in 5 patients so there’s false negative rate 17.2% if SLNB was done alone, so with targeted procedure we can decrease the false negative rate of sentinel study and accurately assess the neoadjuvant effect on the diseased LNs.