Abstract
Introduction
Surgical management of the axilla in patients with clinically node-positive breast
cancer has shifted to less invasive surgical approaches, such as sentinel lymph node
dissection (SLND) and targeted axillary dissection (TAD). Successful retrieval of
the biopsy clip marking the lymph node of interest is crucial for assessment of pathologic
response and locoregional disease control.
Methods
We performed a retrospective review of patients ≥18 years old with invasive breast
cancer and biopsy-proven axillary LN involvement, who underwent LN clip placement
from January 2012 to July 2017 at Johns Hopkins Hospital.
Results
Of the 128 eligible patients, the median age at diagnosis was 51.5 years (range, 23-92
years) with predominately stage T2-3 disease (54.7% T2, 42.2% T3), of ductal histology
(76.6%), and located in the upper outer quadrant (42.2%). Among the 63.3% (81) of
patients who received neoadjuvant systemic therapy, 43.2% (35) had a partial response
and 30.9% (25) had a complete response. Axillary procedures performed consisted of
36.7% (47) SLND/TAD, 53.9% (69) ALND, and 9.4% (12) SLND/TAD with conversion to ALND.
The clipped LN was successfully retrieved in 63.8% (30) of SLND/TADs, 39.1% (27) of
ALNDs, and 58.3% (7) of SLND/TADs followed by ALND. Pre-operative node localization
by wire and/or skin markings was performed for 16.4% (21) of patients. Among these,
90.5% (19) of clipped LNs were successfully retrieved, compared to 42.1% (45) retrieved
in axillary procedures without preoperative node localization.
Conclusion
Use of preoperative targeted node localization improved rate of clipped LN retrieval
across all three types of axillary procedures.
Keywords
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Article info
Publication history
Published online: December 16, 2022
Accepted:
December 13,
2022
Received in revised form:
December 11,
2022
Received:
August 22,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
