Equivalent survival in targeted axillary dissection compared to axillary lymph node dissection in patients with node positive breast cancer receiving neoadjuvant chemotherapy
In brief
Targeted axillary dissection matches survival of full node removal after chemo
In a retrospective series of 284 women with node-positive breast cancer treated with neoadjuvant chemotherapy, targeted axillary dissection (TAD) produced mortality, disease-free survival and overall survival rates indistinguishable from those after traditional axillary lymph node dissection. Recurrence was slightly higher after full dissection in patients with residual nodal disease, but survival remained equal, suggesting TAD may spare morbidity without compromising outcomes, pending longer follow-up.
- Journal
- Breast cancer research and treatment (Q1)
- Published
- 21 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Callie Hlavin, Zainab Balogun, Danielle R Lavage, Michael S Cowher, Kristin Lupinacci, Quratulain Sabih, et al.
- PMID
- 42768249
- DOI
- 10.1007/s10549-026-08078-1
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 23 September 2026): Targeted axillary dissection vs ALND outcomes
Abstract
BACKGROUND: The role of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in node-positive breast cancer (N + BC) is evolving with opportunities to de-escalate surgery in those with complete axillary pathologic response. SLNB may lead to equivalent outcomes while avoiding the morbidity of axillary lymph node dissection (ALND). METHODS: This is a retrospective analysis of patients with N + BC who received NAC and targeted axillary dissection (TAD) with or without ALND from 2014 to 2021. Patients were categorized according to pathology of the previously positive radioactive seed marked lymph node into complete pathologic response (dSLN-) and persistent disease (dSLN+). We assessed the impact of axillary surgery on recurrence, disease-free survival (DFS), and overall survival (OS). RESULTS: We included 284 female patients with median follow-up of 36.3 months. 128 patients had dSLN-of which 13 (10.2%) had ALND and 115 (89.9%) had TAD. There were 156 dSLN+ patients: 107 (68.6%) ALND and 49 TAD. In both groups, TAD resulted in similar mortality (dSLN-: 15.4% vs. 8.9%, p=.309; dSLN+: 9.3% vs. 10.2%, p = 1.000), DFS (dSLN-:19.6 mos vs. 30.7 mos, p=.166; dSLN+: 30 mos vs. 37 mos, p=.650) and OS (dSLN-: 49.3 mos vs. 45.8 mos, p=.868; dSLN+: 36.4 months vs. 36.2 months, p=.982) compared to ALND. CONCLUSION: For patients with dSLN-, there was no difference in recurrence, mortality, DFS, or OS between ALND and TAD. While there was a higher frequency of recurrence in patients who had dSLN + and underwent ALND compared to TAD, there was no difference in DFS or OS. CLINICAL TRIALS NUMBER: Not applicable.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.