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[Members Only] J.Jpn. Surg. Soc.. 125(5): 435-442, 2024
Feature topic
CURRENT STATUS OF TARGETED AXILLARY DISSECTION IN THE OMISSION OF AXILLARY LYMPH NODE DISSECTION
Targeted axillary dissection (TAD) has recently received attention as a minimally invasive axillary surgery for breast cancer patients with positive lymph node metastasis. Before neoadjuvant chemotherapy (NAC), markers are placed in confirmed metastatic lymph nodes. For patients who have a good response to NAC, the procedure is performed as a selection test for those in whom axillary lymph node dissection can be omitted by retrieving the marked lymph nodes in addition to sentinel lymph node biopsy. Five steps including staging, marking of target lymph nodes, tracing, imaging assessment, and localization for precise retrieval are conducted to improve patient selection accuracy. Various markers such as radioactive seeds, magnetic markers, clips, and carbon ink are used globally. While TAD is recommended in guidelines worldwide, its adoption in Japan is limited due to markers not being covered by medical insurance. Further data accumulation, including infrastructure development, is needed for widespread adoption of this minimally invasive axillary surgery in Japanese clinical practice.
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