# The Evolving Role of Marked Lymph Node Biopsy (MLNB) and Targeted Axillary Dissection (TAD) after Neoadjuvant Chemotherapy (NACT) for Node-Positive Breast Cancer: Systematic Review and Pooled Analysis

**Autores:** Parinita K Swarnkar, Salim Tayeh, Michael J Michell, Kefah Mokbel
**Revista:** Cancers (Basel) (2021)
**PMID:** 33810544 | **PMCID:** PMC8037051
**DOI:** [10.3390/cancers13071539](https://doi.org/10.3390/cancers13071539)
**Fuente:** PubMed Central (open access full-text)

## Relevancia
Análisis pooled crucial: FNR de MLNB sola 6.28% (366 pacientes) vs TAD (MLNB+SLNB) 5.18% (521 pacientes), diferencia no significativa (p=0.48). Sugiere que SLNB añade información mínima al MLNB y podría omitirse. Tasa de identificación quirúrgica de MLN del 90%. Soporta una potencial simplificación del TAD a MLNB sola.

## Abstract
Targeted axillary dissection (TAD) is a new axillary staging technique that consists of the surgical removal of biopsy-proven positive axillary nodes, which are marked (marked lymph node biopsy (MLNB)) prior to neoadjuvant chemotherapy (NACT) in addition to the sentinel lymph node biopsy (SLNB). In a meta-analysis of more than 3000 patients, we previously reported a false-negative rate (FNR) of 13% using the SLNB alone in this setting. The aim of this systematic review and pooled analysis is to determine the FNR of MLNB alone and TAD (MLNB plus SLNB) compared with the gold standard of complete axillary lymph node dissection (cALND). The PubMed, Cochrane and Google Scholar databases were searched using MeSH-relevant terms and free words. A total of 9 studies of 366 patients that met the inclusion criteria evaluating the FNR of MLNB alone were included in the pooled analysis, yielding a pooled FNR of 6.28% (95% CI: 3.98-9.43). In 13 studies spanning 521 patients, the addition of SLNB to MLNB (TAD) was associated with a FNR of 5.18% (95% CI: 3.41-7.54), which was not significantly different from that of MLNB alone (p = 0.48). Data regarding the oncological safety of this approach were lacking. In a separate analysis of all published studies reporting successful identification and surgical retrieval of the MLN, we calculated a pooled success rate of 90.0% (95% CI: 85.1-95.1). The present pooled analysis demonstrates that the FNR associated with MLNB alone or combined with SLNB is acceptably low and both approaches are highly accurate in staging the axilla in patients with node-positive breast cancer after NACT. The SLNB adds minimal new information and therefore can be safely omitted from TAD. Further research to confirm the oncological safety of this de-escalation approach of axillary surgery is required. MLNB alone and TAD are associated with acceptably low FNRs and represent valid alternatives to cALND in patients with node-positive breast cancer after excellent response to NACT.

## Texto completo
Texto completo disponible en PMC: [PMC8037051](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037051/). El artículo presenta evidencia que sugiere que MLNB sola puede ser tan precisa como TAD (MLNB+SLNB) en pacientes cN+ post-QT neoadyuvante, con FNR similar (6.28% vs 5.18%) y altas tasas de identificación del ganglio marcado. Aporta una vía conceptual para mayor simplificación de la cirugía axilar en buenos respondedores, sin perjuicio de la precisión diagnóstica.

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*Datos de PubMed. Citar: doi 10.3390/cancers13071539*
