Feasibility and safety of targeted axillary dissection guided by intraoperative ultrasound after neoadjuvant treatment

Background: Axillary management in cN + axillary nodes after neoadjuvant systemic therapy (NST) in breast cancer (BC) remains under research with the aim of de-escalation of axillary node dissection (ALND). Several axillary guided localization techniques have been reported. This study evaluates the...

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Detalles Bibliográficos
Autores: Siso, C. (Christian)|||/items/6dae2f0e-0060-40bf-80e8-1bcbd0069c23, Esgueva-Colmenarejo, A.J. (Antonio Jesús)|||/items/6ac599b0-e00c-4f06-83d5-fef7b7d58c3f, Rivero, J. (J.)|||/items/5f89e584-f8c0-4e0d-ad3f-df3e680651d7, Morales, C. (Clara)|||/items/af26f808-57a5-4562-a1d3-e2917104e05f, Miranda, I. (Ignacio)|||/items/4425055d-3b10-4a1e-86f2-3778f68f8e89, Peg, V. (Vicente)|||/items/af77e8b6-bcfd-415e-84f9-869cbb76e0d4, Gil-Moreno, A. (Antonio)|||/items/a83c1450-d2be-4a93-9397-8ffa91510f9a, Espinosa-Bravo, M. (Martín)|||/items/aa01acbe-6fb2-4342-98a5-7d76627afa7b, Rubio, I.T. (Isabel T.)|||/items/d4321420-81b1-4d5b-bdf6-bec6c75be6d8
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Universidad de Navarra
Repositorio:Dadun. Depósito Académico Digital de la Universidad de Navarra
Idioma:inglés
OAI Identifier:oai:dadun.unav.edu:10171/69227
Acceso en línea:https://hdl.handle.net/10171/69227
Access Level:acceso abierto
Palabra clave:Axillary staging
Intraoperative ultrasound surgery
Marked node
Neoadjuvant systemic therapy
Node positive breast cancer
Targeted axillary dissection
Descripción
Sumario:Background: Axillary management in cN + axillary nodes after neoadjuvant systemic therapy (NST) in breast cancer (BC) remains under research with the aim of de-escalation of axillary node dissection (ALND). Several axillary guided localization techniques have been reported. This study evaluates the safety of intraoperative ultrasound (IOUS) guided targeted axillary dissection (TAD) in a large sample after the results of ILINA trial. Materials: Prospective data have been collected from October 2015 to June 2022 in patients with cT0-T4 and positive axillary lymph nodes (cN1) treated with NST. Before NST, an ultrasound visible marker was placed into the positive node. After NST, IOUS guided TAD was performed including sentinel node biopsy (SLN). Until December 2019, all patients underwent an ALND after TAD procedure. From January 2020, ALND was spared in those patients with an axillary pathological complete response (pCR). Results: 235 patients were included. pCR (ypT0/is ypN0) was achieved in 29% patients. Identification rate (IR) of the clipped node by IOUS was 96% (95% IC, 92.5-98.1%) and IR of SLN was 95% (95% IC, 90.8-97.2%). False negative rate (FNR) for TAD procedure (SLN + clipped node) was 7.0% (95% IC, 2.3-15.7%), which decreased to 4.9% when a total of 3 or more nodes were removed. Axillary ultrasound before surgery assessed residual disease with an AUC of 0.5241. Residual axillary disease tend to be the most significant factor for axillary recurrences. Conclusions: This study confirms the feasibility, safety and accuracy of IOUS guided surgery for axillary staging after NST in node positive BC patients.

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