Kefah Mokbel, Chair of Breast Cancer Surgery at London Breast Institute and Honorary Professor of Medicine at Cardiff University School of Medicine, shared a post on LinkedIn:
“Do SLNB and TAD Deliver Equivalent Axillary Control After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer?
Accurate axillary staging after neoadjuvant chemotherapy (NAC) is critical for guiding adjuvant therapy.
This systematic review and meta-analysis shows that axillary recurrence is very low (0.34% and 0.36% in the TAD and SLNB respectively) and equivalent whether patients undergo sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) after converting from cN+ to ycN0.
Targeted axillary dissection was associated with a statistically significant modest improvement in 3-year disease-free survival; however, follow-up remains insufficient to establish a meaningful impact on overall survival, which did not differ between groups. Although not statistically significant overall survival data also favoured TAD.
At our institution, targeted axillary dissection is the standard approach for patients converting from cN+ to ycN0 after neoadjuvant chemotherapy, reflecting its higher reported staging accuracy compared with sentinel lymph node biopsy aligned with our previous pooled analysis which revealed that the FNR for SLNB vs TAD is 15%:
De-escalation appears safe however TAD may be superior to SLNB alone. Furthermore, overall survival is the ultimate primary endpoint that should be used in such studies.
A clear long-term survival advantage of TAD over SLNB has yet to be demonstrated. These data support a more streamlined, patient-centred approach to axillary surger.”
Title: Wire-Free Targeted Axillary Dissection: A Pooled Analysis of 1300+ Cases Post-Neoadjuvant Systemic Therapy in Node-Positive Early Breast Cancer
Authors: Jajini Varghese, Neill Patani, Umar Wazir, Shonnelly Novintan, Michael J. Michell, Anmol Malhotra, Kinan Mokbel, Kefah Mokbel
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Title: Oncologic Outcomes of Sentinel Lymph Node Biopsy Versus Targeted Axillary Dissection for Node-Positive Breast Cancer Patients After Neoadjuvant Chemotherapy: A Systematic Review and Meta-Analysis
Authors: Hussain A. Abdulla, Jennifer McGarry, Roza Kaczorowska, Andrea Grealish, Claire L. Rutherford, Damian McCartan, Denis Evoy, Jane Rothwell, Ruth S. Prichard, Michael R. Boland
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More posts featuring Kefah Mokbel.