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Targeted Axillary Dissection — SCE Medical Oncology MCQ

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HardBreast CancerTargeted Axillary DissectionSCE Medical Oncology

A 58-year-old woman with node-positive breast cancer has neoadjuvant chemotherapy. Before starting, a clip is placed in the positive axillary node. At surgery, the clipped node is excised alongside sentinel nodes. What technique is this?

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Correct answer: C — Targeted axillary dissection (TAD) — combining removal of the clipped (biopsy-proven positive) node with sentinel lymph node biopsy to improve staging accuracy post-NACT, potentially avoiding full ALND

TAD combines clipped-node excision + SLNB post-NACT, reducing the false-negative rate of SLNB alone (from ~12% to ~2%). If the clipped node and sentinel nodes are negative, ALND can potentially be avoided, sparing patients lymphoedema morbidity. This technique is being adopted for initially node-positive patients who achieve axillary pathological complete response on NACT. NICE NG101 supports discussion of TAD in specialist centres.

Reference: ESMO 2024 Early Breast Cancer; Caudle et al JCO 2016; NICE NG101