Targeted Axillary Dissection Offers a Precise Option in Breast Cancer

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Dr. Kandace P. McGuire discusses how targeted axillary staging differs from traditional methods of staging in patients undergoing breast cancer treatment.

Targeted axillary dissection is used for patients with known positive lymph nodes, allowing surgeons to accurately stage breast cancer, Dr. Kandace P. McGuire emphasized in an interview with CURE® at the 42nd Annual Miami Breast Cancer Conference. She went on to explain that this is done by marking affected nodes and performing a sentinel node biopsy while minimizing the removal of unnecessary lymph nodes, thereby reducing the risk of complications such as lymphedema and nerve damage.

McGuire is a professor of surgery in the Department of Surgical Oncology at the Virginia Commonwealth University (VCU) School of Medicine, VCU Health, and she discussed how targeted axillary staging differs from traditional methods of staging in patients undergoing breast cancer treatment, highlighting what benefits it offers in terms of treatment planning and outcomes.

Glossary:

Targeted axillary dissection: a surgical procedure that removes lymph nodes to stage breast cancer and guide treatment.

Lymphedema: a chronic condition that causes swelling in the body's tissues due to a buildup of lymph fluid.

Transcript:

The targeted axillary dissection is really meant for patients who have known positive lymph nodes. According to our national guidelines, the National Comprehensive Cancer Network Guidelines — which are [what] most surgeons and medical oncologists will use when taking an approach to cancer — you can do the targeted axillary dissection before any whole-body treatment, or you can do it after. However, the technique is the same.

Once you have a biopsy of your lymph node, if it unfortunately has some cancer in it, most radiologists put a little clip in there. That clip is fantastic, because if this ends up being nothing, it can sit there the rest of your life and never bother you. It's made of titanium, but titanium is not detectable in the operating room, and so for the targeted axillary dissection, the surgeons have to ask the radiologist or do it themselves. They need to place some sort of marker that they can find in the operating room. For some people, that's a wire, and for others, it's a non-radioactive seed, so that gets placed ahead of time, which is different from your standard lymph node surgery. Standard lymph node surgery [can include] a sentinel node biopsy, [for example].

The patient then goes to sleep, you inject some dye, it travels up to the lymph nodes and you just take out the ones that light up with the dyes, because they're the ones most likely to have something in it. In this technique, we know there's one with cancer in it, so we mark it so that we can find it, and then we inject the dyes and do the sentinel node biopsy on top of it. What that does is it allows us to do that lymph node biopsy instead of taking out all the lymph nodes in the axilla, which is what most people call the armpit. Underneath that area, most women will have 30 lymph nodes or so, and the huge benefit is to be accurate in staging without taking out a whole bunch of lymph nodes and causing things like lymphedema and nerve damage.

Transcript has been edited for clarity and conciseness.

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