A new meta-analysis confirms the safety and effectiveness of minimally invasive axillary procedures, such as TAD, for breast cancer patients treated with neoadjuvant chemotherapy.
A new meta-analysis published in the European Journal of Surgical Oncology has examined the efficacy and safety of minimally invasive axillary dissection techniques, such as sentinel lymph node biopsy (SLNB), marked lymph node biopsy (MLNB), and transaxillary node dissection ( TAD ), after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer .
The study, led by James Lucocq from the Edinburgh Breast Unit, analyzed 28 studies involving over 3,000 patients, focusing on diagnostic outcomes and survival rates. The findings suggest that TAD demonstrates superior diagnostic accuracy compared to SLNB, with a higher identification rate, lower false-negative rate, and stronger negative predictive value. TAD's effectiveness remained significant even after removing three or more nodes, highlighting its reliability in accurately identifying cancerous lymph nodes. While SLNB showed a lower identification rate in patients achieving complete clinical response to neoadjuvant therapy, both SLNB and TAD proved to be viable alternatives to axillary lymph node dissection (ALND) in terms of long-term disease-free survival (DFS). The study evaluated the identification rate, false-negative rate, and negative predictive value of SLNB, MLNB, and TAD compared to ALND. The results indicated that TAD significantly outperformed SLNB in diagnostic accuracy, boasting a 96.8% identification rate versus SLNB's 91.9%, a 4.7% false-negative rate compared to SLNB's 13.7%, and a 93.2% negative predictive value compared to SLNB's 84.8%. This superiority held even after removing three or more nodes, with TAD still achieving a lower false-negative rate. The meta-analysis also analyzed survival outcomes using nine retrospective studies involving over 5,000 patients. The pooled hazard ratios for DFS in patients undergoing SLNB/TAD, SLNB, and TAD compared to ALND were 0.90, 0.89, and 0.92 respectively, suggesting that SLNB and TAD do not compromise oncological safety. However, the authors acknowledged limitations in the study, including the reliance on retrospective data for survival analysis and the heterogeneity among the included studies. They also highlighted the need for further research investigating the long-term effects of these minimally invasive techniques in different cancer subtypes and patient subgroups
Breast Cancer Neoadjuvant Chemotherapy Axillary Dissection Minimally Invasive Surgery Sentinel Lymph Node Biopsy Transaxillary Node Dissection TAD Survival Outcomes Diagnostic Accuracy
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