Targeted Axillary Dissection After Neo-adjuvant Chemotherapy

  • End date
    Jun 18, 2024
  • participants needed
  • sponsor
    Universitair Ziekenhuis Brussel
Updated on 18 December 2021
triple negative breast cancer
adjuvant chemotherapy
axillary lymph node dissection
sentinel node


Currently most breast cancer patients with confirmed axillary lymph node metastasis (cN1) at diagnosis are candidates for neoadjuvant chemotherapy (NAC). The increased utilization of NAC can be attributed to practical clinical advantages. The increasing use of NAC has, however, introduced questions regarding appropriate loco-regional management, including the optimal surgical approach to the axillary lymph nodes.

According to current guidelines, patients presenting with cN1 disease and treated with NAC, still undergo axillary lymph node dissection (ALND). In forty percent of these patients, however, the investigators see a nodal complete pathological response (ypN0). In certain subgroups, triple negative breast cancer and Her2 amplified breast cancer, this percentage is even higher. The investigators would like to lessen surgical morbidity by performing a targeted axillary dissection. The investigators place a clip in the biopsy-proven lymph node metastasis at diagnosis. After NAC, the investigators perform a dual agent sentinel node procedure and remove the clipped node during the same surgery. When these lymph nodes are microscopically tumor-free, the investigators can abolish an ALND. Targeted axillary dissection after NAC for cN1 disease seems to have acceptable false negative rates in previous trials. The investigators would like to further define patients where an ALND can be safely omitted.

Condition Breast Cancer
Treatment TAD (Targeted Axillary Dissection)
Clinical Study IdentifierNCT05071911
SponsorUniversitair Ziekenhuis Brussel
Last Modified on18 December 2021


Yes No Not Sure

Inclusion Criteria

Patients diagnosed with cT1-3N1M0 breast cancer, histopathologically confirmed
Age greater than or equal to 18 years and less than or equal to 85 years
Necessity and agreement to neoadjuvant chemotherapy

Exclusion Criteria

Previous surgery ipsilateral axillary or radiation ipsilateral axillary / chest
Extranodal metastases M1
cN2-3 status
Breast cancer with direct invasion of chest wall and / or skin cT4
Disease progression (clinical /radiological) under neoadjuvant treatment
Presence of a pacemaker in the ipsilateral chest wall
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