Intraoperative Pathologic Evaluation with Targeted Axillary Dissection

Excerpt

The management of axillary disease in breast cancer patients is constantly evolving; however, the practice of routine axillary clearance for clinically node-positive patients has recently been questioned. With the increased use of neoadjuvant chemotherapy (NAC), as well as increasing efficacy of systemic therapy, a substantial proportion of clinically node-positive patients may achieve a nodal pathologic complete response (pCR) with chemotherapy. Several recent studies have explored minimally invasive techniques to identify those patients who may not benefit from extensive axillary surgery.1^–4 One such approach is targeted axillary dissection (TAD).4,5 With this technique, lymph nodes with biopsy-confirmed metastases are marked with a clip prior to initiating NAC. TAD involves selective localization and removal of the clip, in addition to removal of the sentinel nodes for axillary staging. Wu et al. report their results of using TAD and the use of intraoperative touch imprint cytology to evaluate the excised lymph nodes. They prospectively enrolled patients with biopsy-confirmed nodal metastases who underwent NAC followed by TAD and completion axillary lymph node dissection (ALND). They used intraoperative touch imprint cytology to assess nodes removed by TAD and compared this with the final pathologic results, finding a sensitivity of 87.9% and specificity of 94.9%. The authors found that a false negative result for intraoperative analysis was more likely when only micrometastatic disease remained. …