Objective: To determine the safety and reliability of directed axillary dissection with sentinel node biopsy (SNB) and marked lymph node biopsy (MLNB) with axillary wire on the clipped node, for the selection of patients who are candidates for conservative axillary treatment after the diagnosis of node-positive breast cancer who show a complete axillary response after neoadjuvant treatment. Materials: A prospective cohort study was carried out at Miguel Servet University Hospital in Zaragoza. 66 patients with a diagnosis of breast cancer and initial histological axillary involvement were finally included, in which the biopsied node was marked with a titanium clip prior to the start of neoadjuvant treatment. All patients underwent axillary sampling using SNB or Targeted axillary dissection (TAD) by SNB and MLNB with axillary wire on the clipped node before performing lymphadenectomy. Results: The detection rate (DR) of the SNB was 100% with a mean of 1.8 sentinel nodes studied. In 14 patients, axillary sampling was performed only with SNB, with a false negative rate (FNR) of 14.29%, which decreased when 2 or more nodes were removed or when clipped node was removed. In 51 cases, double marking with SNB and MLNB with axillary wire was performed, which ensures excision of the clipped node in 96.1% of cases with a FNR of 1.96%. The negative predictive value (NPV) of the sample when the clipped node is studied was 96.8%. Conclusions: Targeted axillary dissection with SNB and MLNB with axillary wire on the clipped node is a safe and effective strategy for the selection of patients who are candidates for conservative axillary treatment after neoadjuvant treatment, avoiding unnecessary lymphadenectomies.
Cite this article
Volume | Year
Open Access Original Research
Evaluation of axillary response to neoadjuvant systemic therapy with sentinel node biopsy and axillary wire in node-positive breast cancer
Javier Navarro Sierra1,*, Patricia Rubio Cuesta1, Francisco Javier Villalobos Salguero1, Andrea Espiau Romera2, María del Carmen García Mur3, Isabel Vicente Gómez1
1 Department of Obstetrics & Gynecology of Miguel Servet University Hospital, 50009 Zaragoza, Spain
2 Department of Obstetrics & Gynecology of Lozano Blesa University Clinical Hospital, 50009 Zaragoza, Spain
3 Department of Breast Radiodiagnosis of Miguel Servet University Hospital, 50009 Zaragoza, Spain
Eur. J. Gynaecol. Oncol. 2021, 42(6), 1291–1299; https://doi.org/10.31083/j.ejgo4206186
Submitted: 8 June 2021 | Revised: 20 July 2021 | Accepted: 23 July 2021 | Published: 15 December 2021
(This article belongs to the Special Issue Selected papers from the 2021 AGOA Society)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).
Node-positive breast cancer
Neoadjuvant systemic therapy
Sentinel node biopsy