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Introduction. Modern neoadjuvant therapy (NAT) regimens achieve a pathologic complete response in both the primary tumor and axillary lymph nodes in a significant proportion of patients with aggressive early-stage breast cancer (BC). This outcome underscores the relevance of surgical de-escalation strategies in regional nodal management for this patient population.
Aim. To develop and evaluate the initial outcomes of a novel Navigated Targeted Axillary Dissection (NAVI-TAD) technique for patients achieving nodal downstaging (cN+ to ycN0) after NAT.
Materials and Methods. This prospective study included 30 patients with early-stage breast cancer (cT1-3N1M0) and histologically confirmed involvement of 1−2 axillary lymph nodes who achieved node-negative status (ycN0) on clinical/imaging restaging after NAT. All patients underwent radical breast surgery with NAVI-TAD. Prior to surgery, the target lymph node (marked with a titanium clip before initiating NAT) was localized under ultrasound guidance via a perinodal injection of 0.4 ml of a 4 mg/ml indigo carmine solution. Standard technetium-99m-based sentinel lymph node (SLN) mapping was performed concurrently. Surgical specimens underwent immediate intraoperative radiography (to identify the clip) and histopathological examination.
Results. NAVI-TAD was technically successful in 29 of 30 cases (96.7 %). A median of fewer than three lymph nodes were removed per procedure. Intraoperative histology confirmed a complete nodal pathologic response (ypN0) in 43.3 % of patients, allowing for immediate intraoperative decision-making regarding the scope of surgery. SLN biopsy was successful in 83.3 % of cases. In 5 patients where SLN mapping failed, the NAVI-TAD technique successfully identified the target node in 4 cases. A critical finding was discordance between the target node and the SLN in 20 % of patients, a result that directly impacted the decision to escalate or modify adjuvant systemic therapy.
Conclusion. The NAVI-TAD technique is a safe and highly informative surgical approach, offering a precise alternative to standard axillary lymph node dissection for initially node-positive (cN+) BC patients after NAT.
References
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