[The role of targeted axillary surgery in the treatment of breast cancer patients using the SAVI SCOUT® radar localization technique].

INTRODUCTION

Sentinel lymph node biopsy is the standard procedure in the treatment of breast cancer. After neodjuvant therapy, patients with initially positive axillary nodes (cN1) may convert to clinically negative status (ycN0). In these cases, the use of sentinel lymph node biopsy alone may be questionable due to its relatively high false-negative rate exceeding 10%.

OBJECTIVE

To observe whether targeted axillary dissection combining with biopsy of a previously marked lymph node, offers a potential solution.

METHOD: Between June 20, 2023 and November 6, 2024, SAVI SCOUT® radar reflector localization was used in 18 breast cancer patients with cT1-cT2cN1cM0 status. Sentinel lymph node biopsy was performed using dual tracers, while marked lymph node biopsy was guided by the SAVI SCOUT® system. If conversion from cN1 to ycN0 was confirmed after neoadjuvant therapy, targeted axillary dissection was performed. When no metastasis was detected in the excised lymph nodes, no further axillary surgery was carried out; if micrometastasis or macrometastasis was confirmed histologically, axillary lymph node dissection followed.

RESULTS

Before neoadjuvant therapy, 18 patients had metastatic axillary lymph nodes marked. Surgery has been completed in 10 patients. In 1 case, cN1 status persisted after neoadjuvant treatment, leading to axillary lymph node dissection. In 9 patients, conversion from cN1 to ycN0 occurred, and targeted axillary dissection was performed. The marked lymph node was successfully identified in all cases. In 4 cases, axillary lymph node dissection was avoided, and 2 patients achieved a pathological complete response. In the remaining 5 cases, micro- or macrometastases were detected, necessitating axillary lymph node dissection. No targeted axillary dissection-related complications occurred.

CONCLUSION

The SAVI SCOUT® radar reflector localization technique proved to be a safe and feasible method, allowing for the precise removal of metastatic lymph nodes marked prior to neoadjuvant treatment. Targeted axillary dissection was found to be an accurate and reliable staging procedure that may help avoid axillary lymph node dissection and reduce surgical morbidity. Orv Hetil. 2026; 167(1): 2-8.