Targeted axillary dissection using Magseed magnetic bead in female patients with breast cancer.

INTRODUCTION: The optimal surgical management of Lymph Nodes (LNs) following Neoadjuvant Systemic Therapy (NACT) remains a subject of clinical debate. Targeted Axillary Dissection (TAD) aims to improve staging accuracy by identifying the initially metastatic node. The prerequisite for TAD is the identification of the initially most prominent pathological nodule in the axilla before the start of treatment. METHODS: This study presents a retrospective observational study of breast cancer after Neoadjuvant Systemic Therapy (NACT), from 2021 to 2024. The study primarily focused on the diagnosis of LN conditions and the surgical procedures performed. This study included n = 58 female patients with biopsy-proven cN1 breast cancer. RESULTS: The patients with initially positive axillary LNs were evaluated. Before the start of NACT, the biopsy of the pathological node was performed and also labeled with a Magseed magnetic marker. After NACT, a standard sentinel lymph node protocol was performed with preoperative lymphoscintigraphy with Technetium colloid. Significantly, there was never a case in which a labeled node was negative while metastases were in other nodes. In 4/58 (6.9%) cases, the common sentinel nodes were negative, while the labeled TAD node was positive. CONCLUSION: The labeled node appears to represent the status of LNs more accurately after NACT than conventional ones. The metastatic nodes can be spared with axillary dissection using neoadjuvant treatment and TAD; however, the long-term oncologic outcomes of this approach are not yet reliably known.