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.