Recent advances in neoadjuvant systemic therapy (NST) have significantly improved pathologic complete response rates in early breast cancer, challenging the role of axillary lymph node dissection in nose-positive patients. Targeted axillary dissection (TAD) integrates marked lymph node biopsy (MLNB) and tracer-guided sentinel lymph node biopsy (SLNB). The introduction of new wire-free localisation markers (LMs) has streamlined TAD and increased its adoption. The primary endpoints include the successful localisation and retrieval rates of LMs. The secondary endpoints include the pathological complete response (pCR), SLNB, and MLNB concordance, as well as false-negative rates. Seventeen studies encompassing 1358 TAD procedures in 1355 met the inclusion criteria. The localisation and retrieval rate of LMs were 97% and 99%. A concordance rate of 67% (95% CI: 64–70) between SLNB and MLNB was demonstrated. Notably, 49 days (range: 0–272) was the average LM deployment time to surgery. pCR was observed in 46% (95% CI: 43–49) of cases, with no significant procedure-related complications. Omitting MLNB or SLNB would have under-staged the axilla in 15.2% or 5.4% (p= 0.0001) of cases, respectively. MLNB inclusion in axillary staging post-NST for initially node-positive patients is crucial. The radiation-free Savi Scout, with its minimal MRI artefacts, is the preferred technology for TAD.
新辅助系统治疗（NST）的最新进展显著提高了早期乳腺癌的病理完全缓解率，对腋窝淋巴结阳性患者中腋窝淋巴结清扫术的作用提出了挑战。靶向腋窝淋巴结清扫术（TAD）结合了标记淋巴结活检（MLNB）和示踪剂引导的前哨淋巴结活检（SLNB）。新型无线定位标记物（LMs）的引入简化了TAD流程并促进了其应用。主要终点包括LMs的成功定位率和取出率。次要终点包括病理完全缓解（pCR）、SLNB与MLNB的一致性以及假阴性率。共17项研究纳入分析，涵盖1355例患者的1358次TAD操作，符合纳入标准。LMs的定位成功率为97%，取出率为99%。SLNB与MLNB的一致性率为67%（95% CI：64–70）。值得注意的是，从LMs置入到手术的平均时间为49天（范围：0–272天）。46%的病例（95% CI：43–49）达到pCR，且未出现显著的手术相关并发症。若省略MLNB或SLNB，将分别导致15.2%或5.4%（p=0.0001）的病例腋窝分期不足。对于初始淋巴结阳性患者，在NST后腋窝分期中纳入MLNB至关重要。无辐射的Savi Scout系统因其在MRI中产生的伪影极小，成为TAD的首选技术。
肿瘤(癌症)患者之家