Targeted axillary dissection in breast cancer: An overview of various techniques and their effectiveness. Systematic review

The introduction of effective neoadjuvant systemic therapy contributed to significant advances in the treatment of breast cancer, especially the most aggressive subtypes of this disease – triple negative and HER2-positive. The high effectiveness of the neoadjuvant therapy led to a high rate of the pathological complete response in the primary tumor and lymph nodes, which contributed to the de-escalation of surgery on both the breast and the regional lymphatic collector. Targeted axillary dissection (TAD) has taken a special place in clinical practice as a modern method of surgical staging in patients with breast cancer and metastatic lymph node involvement after neoadjuvant systemic therapy. A systematic review analyzed the results of several studies comparing different TAD techniques, with special attention paid to comparing one-stage (labeling of affected lymph nodes before chemotherapy) and two-stage (labeling before chemotherapy with subsequent pre- or intraoperative localization) approaches, as well as assessing the effectiveness of various markers, including radioactive seed implants (¹²⁵I), magnetic tags, carbon suspensions, metal staples, etc. The review highlighted the significant heterogeneity of the available protocols and emphasized the need for randomized controlled trials to standardize the TAD methodology, assess its long-term oncological safety, and establish optimal approaches to lymph node labeling.