E1615. Targeted Axillary Dissection: History and Updates
University of Texas MD Anderson Cancer Center
Targeted axillary dissection is an increasingly common procedure in the treatment of breast cancer. This presentation will inform trainees and practicing radiologists of history and updates regarding targeted axillary dissection.
Educational Goals / Teaching Points
The goals of this exhibit are to review the anatomy and pathology that led to creation of the targeted axillary dissection procedure; understand the strength and weakness of axillary node dissection and sentinel node dissection; and learn the indications for targeted axillary dissection and possible developments on the horizon.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Important anatomic and pathophysiologic issues include nodal metastases involving the sentinel node and any anatomically abnormal lymph nodes identified mammographically or sonographically. By performing a biopsy of sonographically abnormal lymph nodes and marking them with a clip, surgical excision and localization can be performed in addition to sentinel node biopsy. Together, these nodes give a more accurate picture of true nodal status in the setting of lymph node metastases.
Sentinel node biopsy is a good prognostic indicator of axillary nodal status regarding nodal metastases in cases of invasive breast cancer. However, the rate of false negatives is around 10%. This rate may be substantially improved by including sonographically abnormal lymph nodes within localization specimen for pathologic analysis.