353 Targeted Axillary Dissection Does Benefit Patients with a Single Positive Node Prior to Neoadjuvant Chemotherapy

Abstract

Abstract Aim Targeted Axillary Dissection (TAD) is a procedure where positive axillary nodes are clipped with a view to sentinel lymph node dissection plus removal of clipped nodes post-neoadjuvant therapies (NACT) rather than axillary lymph node clearance (ANC), reducing morbidity. This study aimed to assess whether patients with a single positive node undergoing NACT would benefit from TAD. Method Patients planned for TAD post-NACT were identified from the surgical diary from March 2020 – July 2022. Data were recorded for age, histopathology, MRI response and surgical procedure. Results Eighteen women were identified, mean age 46.7 (33- 63 years). 44% (8) had ER positive, HER2 negative invasive ductal carcinoma (IDC), 28% (5) had HER2 positive IDC, 22% (4) had triple negative IDC and 6% (1) had ER positive, HER2 negative lobular carcinoma. Treatment response on MRI was complete in 22% (4), near complete or very good in 11%(2), partial in 61% (11) with 6% (1) patient having stable disease. Four patients including the patient who had no response to chemotherapy opted for ANC post-NACT. Only 17% (1/6) patients with complete or good response had positive nodes post-NACT whereas 58% (7/12) of patients with partial or no response had positive nodes post-NACT. Conclusions Although the numbers in our study are small, TAD did benefit patients with a single positive node who have complete or good response to NACT. Larger multicentre studies are needed to confirm this and determine whether TAD is of benefit in patients who have partial or no response.