„Targeted axillary dissection“ – Standard oder noch experimentell?

Background: Targeted axillary dissection (TAD) has been proposed as a possible alternative to axillary staging in initially node-positive breast cancer patients undergoing neoadjuvant systemic treatment (NST) and achieving a clinical complete response in the axilla. However, the available evidence is incomplete and many questions still remain unanswered. Objective: The aim of the present work was to provide a review of the currently published data regarding TAD, including marking techniques, localization techniques, rates of successfully removing the target lymph node (TLN), and the false-negative rate (FNR). Moreover, the authors wished to elucidate the study landscape. Materials and methods: This work reviews published articles and abstracts on TAD. Results: The published articles report on an FNR of less than 10%. The optimal marking technique remains unclear. Different tools are used, such as clips or coils that are wire marked preoperatively, radioactive seeds that have to be detected via a gamma probe, magnetic seeds that require detection with a magnetic probe, and the use of a charcoal suspension for visual identification of the TLN. To date, only one magnetic seed is approved for lymph node marking prior to NST and is being evaluated in ongoing trials. There is evidence that an initially lower tumor burden in the axilla is associated with a lower FNR. Conclusion: As TAD has already been introduced into clinical routine, it is important to use this technique wisely and to include these patients in clinical trials.