Diagnostic accuracy of sentinel lymph node biopsy and wire localized clipped node biopsy after neoadjuvant chemotherapy in node-positive breast cancer

The optimal method for axillary staging in patients with initially node-positive breast cancer after NACT remains unclear.

We conducted a prospective, single-center trial to investigate the diagnostic performance of sentinel lymph node biopsy (SLNB) combined with wire localized lymph node biopsy (WLNB) of the clip-marked node as an axillary staging technique in patients with node-positive breast cancer after neoadjuvant chemotherapy (NACT).

A total of 233 patients were enrolled, 208 of whom were included in the analysis. The IR of SLNB and WLNB alone were 63.0% and 70.7%, respectively. The identification rate (IR) of targeted axillary dissection (TAD) was 87.5%. The FNR of and NPV were 6.9% (95% confidence interval [CI]:2.0–11.8%) and 92.0% (95% CI 86.3–97.7%), respectively, for the TAD procedure, 17.1% (95% CI 8.2–25.6%) and 83.3% (95% CI:74.7–91.9%) for SLNB alone, and 6.7% (95% CI:1.5–12.0%) and 90.6% (95% CI:83.5–97.7%) for WLNB alone.

The diagnostic performance of TAD using wire localization was similar to that of the procedure performed using radioactive seed localization. (Clinical Trial Registration: NCT03715686).