Targeted Axillary Dissection In Breast Cancer Patients After Neoadjuvant Therapy

Abstract

In the last 20 years, axillary surgery for breast cancer has changed dramatically. In clinically node-positive patients, ALND is the conventional procedure. With the development of efficient neo-adjuvant chemotherapy (NACT), there is a shift toward less aggressive operation in patients who have clinical signs of excellent response and disease shrinkage. Therefore, SLN biopsy (SLNB), which offers an accurate, less morbid staging procedure that prevents complications of ALND has become the standard technique in node negative early breast cancer. In these patients, However, there has been a reluctance to perform (SLNB) after completion of NACT in patients with histologically proven axillary metastases because of false-negative rates (FNRs) greater than 10%. To deal with this problem, a new and promising technique called targeted axillary dissection (TAD) has been developed for determining axillary status in postneoadjuvant chemotherapy (NACT) node-positive breast cancer patients. It includes removal of the SLN as well as the pathologically proven positive nodes which have to be marked before starting the NACT. TAD can be considered a practical, reproducible, and valid method for ruling out metastatic axillary involvement in patients with breast cancer who have had a favourable response to NACT