TARGETED AXILLARY DISSECTION VS. SENTINEL LYMPH NODE BIOPSY ALONE VS. AXILLARY LYMPH NODE DISSECTION IN NODE POSITIVE BREAST CANCER AFTER NEO ADJUVENT THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS shahbikash2058@gmail.com

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TARGETED AXILLARY DISSECTION VS. SENTINEL LYMPH NODE BIOPSY ALONE VS. AXILLARY LYMPH NODE DISSECTION IN NODE POSITIVE BREAST CANCER AFTER NEO ADJUVENT THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS

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Nepal

Oral or Poster

Management of axillary disease in breast cancer patients receiving neoadjuvant therapy (NAT) remains controversial. Axillary Lymph Node Dissection(ALND) provides detailed evaluation, however minimally invasive procedures including Sentinel Lymph Node Biopsy(SLNB) are promising. This study evaluates the comparative effectiveness of these three axillary staging strategies in terms of diagnostic accuracy, oncologic safety, and patient morbidity.

Conforming to PRISMA guidelines, a systematic review encompassing MEDLINE, Embase, Cochrane Central, and Scopus employing targeted search strategies was conducted, selecting 30 studies (10 prospective trials, 20 retrospective cohorts). Pooled estimates for false-negative rates (FNR), axillary recurrence, survival outcomes, and morbidity were calculated using random-effects models. Subgroup analyses examined the impact of tracer methods, number of nodes retrieved, and pathologic response.

TAD demonstrated better staging accuracy with an FNR of 4.8% (95% CI: 3.2-7.1%) versus 14.3% for SLNB alone (95% CI: 11.2-18.1%). Axillary recurrence rates were lowest with TAD (1.2%) compared to SLNB (4.1%) and ALND (3.8%). No significant survival differences were seen between techniques in ypN0 patients. Lymphedema incidence was significantly lower with TAD (2.1%) versus ALND (24.6%).

TAD brings optimal balance between staging accuracy and reduced morbidity for node positive breast cancer patients who achieve ypN0 status after NAT. SLNB alone may be adequate when stringent technical criteria are met, while ALND remains necessary for patients with persistent nodal disease.