Evaluation of targeted axillary lymph node dissection in node positive breast cancer patients post neoadjuvant therapy

Abstract

Background: Targeted axillary dissection (TAD) involves locating and removing a previously marked lymph node to improve staging accuracy and potentially avoid more extensive axillary surgery. This study aims to assess its accuracy in axillary staging and postoperative morbidity in this setting. This study evaluates TAD in node-positive breast cancer patients after neoadjuvant therapy. Methods: This prospective study included 60 patients with invasive breast cancer and axillary metastasis treated at Assiut University Hospitals. Patients underwent triple assessment, biopsy, clipping of nodes, and neoadjuvant chemotherapy tailored to tumor subtype. Surgical management involved breast surgery with sentinel lymph node biopsy and targeted axillary dissection. Outcomes assessed included diagnostic accuracy, postoperative complications, and treatment response. Results: In this study of 60 breast cancer patients, 20% had hypertension, 21.67% diabetes, and 26.67% family history. Most tumors were right-sided (55%), single (81.67%), and invasive ductal carcinoma (90%). Molecular subtypes included luminal B (38.3%) and triple negative (41.67%). Breast-conserving surgery was performed in 73.3%, with lymph node metastasis in 53.3%. Targeted axillary dissection (TAD) achieved 98.33% localization success and showed 90.6% sensitivity and 89.8% accuracy, outperforming sentinel lymph node dissection (81.3% sensitivity, 85% accuracy). Postoperative complications were minimal (6.67% lymphedema, 10% paraesthesia), and concordance between TAD and SLND was high (95%). Conclusions: TAD demonstrates reliable diagnostic performance for axillary staging in node-positive breast cancer patients who turned negative after NACT, outperforming SLND and showing minimal short-term postoperative morbidity. It offers a less invasive alternative to ALND when combined with dual localization and imaging. Larger, multicenter studies with longer follow-up are recommended to confirm long-term safety and validate patient selection criteria.