Evaluation of targeted axillary dissection in node positive locally advanced breast cancer patients with complete pathological response to neoadjuvant chemotherapy

Abstract

Background This study aimed to evaluate targeted axillary dissection in node locally advanced node positive breast cancer patients with complete pathological response to neoadjuvant chemotherapy. Patients and methods This is a prospective cohort study including 25 females diagnosed with locally advanced breast cancer with proven lymph node involvement who had complete pathological response to the neoadjuvant chemotherapy regarding the clipped previously involved lymph node. Lymph node biopsy and frozen section of the clipped lymph node after wire localization and the sentinel lymph node after patent blue dye injection was done. This is followed by paraffin section examination of the lymph node biopsy and 6 months follow-up for the patients. Results Twenty-four patients out of 25 patients had successful localization of the clipped and sentinel lymph node with no macrometastasis detected in frozen section. Twenty-two out of the 24 patients had no micrometastasis in paraffin section. Two of the 24 patients had micrometastasis on paraffin section and required axillary radiotherapy. One of the 25 patients failed localization of the clipped lymph node and received conventional axillary lymph node dissection. Two patients developed lymphedema, one of them after axillary radiotherapy, and the other one after axillary lymph node dissection. Conclusion The combination of targeted axillary dissection and sentinel lymph node biopsy can replace axillary clearance in patients with node positive locally advanced breast cancer with complete pathological response to neoadjuvant chemotherapy.