Improved axillary evaluation following neoadjuvant therapy for patientswith node-positive breast cancer using selective evaluation of clipped nodes: Implementation of targeted axillary dissection

Abigail S. Caudle, Wei T. Yang, Savitri Krishnamurthy, Elizabeth A. Mittendorf, Dalliah M. Black, Michael Z. Gilcrease, Isabelle Bedrosian, Brian P. Hobbs, Sarah M. Desnyder, Rosa F. Hwang, Beatriz E. Adrada, Simona F. Shaitelman, Mariana Chavez-Macgregor, Benjamin D. Smith, Rosalind P. Candelaria, Gildy V. Babiera, Basak E. Dogan, Lumarie Santiago, Kelly K. Hunt, Henry M. Kuerer

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208 Scopus citations

Abstract

Purpose: Placing clips in nodes with biopsy-confirmed metastasis before initiating neoadjuvant therapy allows for evaluation of response in breast cancer. Our goal was to determine if pathologic changes in clipped nodes reflect the status of the nodal basin and if targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of clipped nodes, improves the false-negative rate (FNR) compared with SLND alone. Methods: A prospective study of patients with biopsy-confirmed nodal metastases with a clip placed in the sampled node was performed. After neoadjuvant therapy, patients underwent axillary surgery and the pathology of the clipped node was compared with other nodes. Patients undergoing TAD had SLND and selective removal of the clipped node using iodine-125 seed localization. The FNR was determined in patients undergoing complete axillary lymphadenectomy (ALND). Results: Of 208 patients enrolled in this study, 191 underwent ALND, with residual disease identified in 120 (63%). The clipped node revealed metastases in 115 patients, resulting in an FNR of 4.2% (95% CI, 1.4 to 9.5) for the clipped node. In patients undergoing SLND and ALND (n = 118), the FNR was 10.1% (95% CI, 4.2 to 19.8), which included seven false-negative events in 69 patients with residual disease. Adding evaluation of the clipped node reduced the FNR to 1.4% (95% CI, 0.03 to 7.3; P =.03). The clipped node was not retrieved as an SLN in 23% (31 of 134) of patients, including six with negative SLNs but metastasis in the clipped node. TAD followed by ALND was performed in 85 patients, with an FNR of 2.0% (1 of 50; 95% CI, 0.05 to 10.7). Conclusion: Marking nodes with biopsy-confirmed metastatic disease allows for selective removal and improves pathologic evaluation for residual nodal disease after chemotherapy.

Original languageEnglish (US)
Pages (from-to)1072-1078
Number of pages7
JournalJournal of Clinical Oncology
Volume34
Issue number10
DOIs
StatePublished - Apr 1 2016

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Caudle, A. S., Yang, W. T., Krishnamurthy, S., Mittendorf, E. A., Black, D. M., Gilcrease, M. Z., Bedrosian, I., Hobbs, B. P., Desnyder, S. M., Hwang, R. F., Adrada, B. E., Shaitelman, S. F., Chavez-Macgregor, M., Smith, B. D., Candelaria, R. P., Babiera, G. V., Dogan, B. E., Santiago, L., Hunt, K. K., & Kuerer, H. M. (2016). Improved axillary evaluation following neoadjuvant therapy for patientswith node-positive breast cancer using selective evaluation of clipped nodes: Implementation of targeted axillary dissection. Journal of Clinical Oncology, 34(10), 1072-1078. https://doi.org/10.1200/JCO.2015.64.0094