Author:
Switalla Kayla M.,Boughey Judy C.,Dimitroff Katrina,Yau Christina,Ladores Velle,Yu Hongmei,Tchou Julia,Golshan Mehra,Ahrendt Gretchen,Postlewait Lauren M.,Piltin Mara,Reyna Chantal R.,Matsen Cindy B.,Tuttle Todd M.,Wallace Anne M.,Arciero Cletus A.,Lee Marie Catherine,Tseng Jennifer,Son Jennifer,Rao Roshni,Sauder Candice,Naik Arpana,Howard-McNatt Marissa,Lancaster Rachael,Norwood Peter,Esserman Laura J.,Mukhtar Rita A.
Abstract
Abstract
Background
For patients with clinically node-positive (cN+) breast cancer undergoing neoadjuvant chemotherapy (NAC), retrieving previously clipped, biopsy-proven positive lymph nodes during sentinel lymph node biopsy [i.e., targeted axillary dissection (TAD)] may reduce false negative rates. However, the overall utilization and impact of clipping positive nodes remains uncertain.
Patients and Methods
We retrospectively analyzed cN+ ISPY-2 patients (2011–2022) undergoing axillary surgery after NAC. We evaluated trends in node clipping and associations with type of axillary surgery [sentinel lymph node (SLN) only, SLN and axillary lymph node dissection (ALND), or ALND only] and event-free survival (EFS) in patients that were cN+ on a NAC trial.
Results
Among 801 cN+ patients, 161 (20.1%) had pre-NAC clip placement in the positive node. The proportion of patients that were cN+ undergoing clip placement increased from 2.4 to 36.2% between 2011 and 2021. Multivariable logistic regression showed nodal clipping was independently associated with higher odds of SLN-only surgery [odds ratio (OR) 4.3, 95% confidence interval (CI) 2.8–6.8, p < 0.001]. This was also true among patients with residual pathologically node-positive (pN+) disease. Completion ALND rate did not differ based on clip retrieval success. No significant differences in EFS were observed in those with or without clip placement, both with or without successful clip retrieval [hazard ratio (HR) 0.85, 95% CI 0.4–1.7, p = 0.7; HR 1.8, 95% CI 0.5–6.0, p = 0.3, respectively].
Conclusion
Clip placement in the positive lymph node before NAC is increasingly common. The significant association between clip placement and omission of axillary dissection, even among patients with pN+ disease, suggests a paradigm shift toward TAD as a definitive surgical management strategy in patients with pN+ disease after NAC.
Funder
Quantum Leap Healthcare Collaborative
Publisher
Springer Science and Business Media LLC
Cited by
1 articles.
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