Agreement between sentinel node and clipped node in targeted axillary dissection. Systematic literature review

Patients with breast cancer and nodal involvement are routinely referred for axillary emptying. In cases where positive nodes are negative after chemotherapy, patients may be selected for targeted axillary dissection. This technique consists of marking the positive node and then administering neoadjuvant systemic management. If a complete clinical and imaging response is achieved, patients are taken to resection of the marked node and sentinel nodes. This procedure allows good locoregional control of the disease, avoids futile axillary emptying and reduces the percentage of post-surgical complications such as lymphedema. The objective of our review was to describe the agreement between the sentinel node and the clipped node; for this we followed the PRISMA guide and performed a literature search in Pubmed, Embase, LILACS and WoS databases. We found that the agreement between the sentinel node and the clipped node is 70.9%. Performing Targeted Axillary Dissection, even in patients where the clipped node is not found after neoadjuvant treatment, as well as in centers where axillary node marking is not available, is a feasible option taking into account the high concordance between the clipped node and the sentinel nodes. The procedure under these circumstances reduces surgical morbidity of axillary emptying while maintaining oncologic safety.