Targeted axillary dissection using Radioguided Occult Lesion Localization technique in the clinically negative marked lymph node after neoadjuvant treatment in breast cancer patients

Purpose: To be aware of the feasibility of targeted axillary dissection (TAD) injecting 99mTechnetiumlabeled macroaggregated albumin (99mTc-MAA) preoperatively into the clipped lymph node of patients with axillary complete clinical response (ycN0), after neoadjuvant chemotherapy (NAC) for breast cancer.Patients and methods: A retrospective observational study was performed on N1 patients with a clipped positive node and a clinically negative axilla (ycN0) after NAC in one center. The pretreatment positive lymph node was injected with 99mTc-MAA the day before surgery and identified intraoperatively with a radioguided occult lesion localization (ROLL) technique. Patients were subjected to a TAD with the intent of identifying the clipped node and other/s sentinel nodes through a standard sentinel lymph node biopsy (SLNB).Results: 54 patients and 55 axillary clipped nodes were included. The clip was intraoperatively encountered in every patient, accomplishing a 100% detection rate, although in one case no lymphatic tissue could be found in the intraoperative frozen section. An axillary lymph node dissection (ALND) was avoided in 62.9% of the cases (34/54).Conclusion: The use of the ROLL technique is a highly valuable tool since it allows a 100% success rate in retrieving the marker (and a 98.1% rate in detecting the clipped lymph node) in ycN0 breast cancer patients.& COPY; 2023 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Automated summary

The purpose of this study is to evaluate the feasibility of targeted axillary dissection using 99mTechnetiumlabeled macroaggregated albumin (99mTc-MAA) injected preoperatively into the clipped lymph node of patients with axillary complete clinical response (ycN0) after neoadjuvant chemotherapy (NAC) for breast cancer. A retrospective observational study has shown that the use of radioguided occult lesion localization (ROLL) technique can successfully detect the 99mTc-MAA injection and avoid axillary lymph node dissection in 62.9% of the cases.