Patient-reported pain after targeted axillary dissection for breast cancer.

INTRODUCTION

Targeted axillary dissection (TAD) was developed to reduce axillary morbidity in breast cancer by avoiding axillary lymph node dissection (ALND). Morbidity after TAD is expected to align with morbidity after sentinel lymph node biopsy; however, patient populations differ. As long-term morbidity after TAD is unknown, this study examined presence and severity of pain following TAD staging after neoadjuvant treatment.

METHODS

A self-reported, validated questionnaire was sent to patients treated for cN1-3 breast cancer with TAD after neoadjuvant chemotherapy (NACT), with or without completion ALND, between Jan 1, 2017, and Aug 31, 2021. Data collection started in Jan 2025. The primary outcome was presence and severity of pain. Descriptive statistics were used, and a multivariable logistic regression analysis identified factors associated with reporting pain.

RESULTS

Questionnaire response rates were 59% for TAD alone and 50% for TAD with ALND. Median follow-up was 4.6 years. Overall, 59.5% reported pain, with more patients in the TAD with ALND group affected (67% versus 52%, p < .01). Severe pain was reported by 11.3%, with no difference between groups. Axillary surgery type was associated with reporting pain (OR 0.54 for the TAD only group, 95% CI 0.35-0.83, p = <0.01).

CONCLUSIONS

TAD alone reduces the odds of reporting pain by approximately 50%, yet persistent pain is common, affecting half of the patients staged with TAD alone. Two-thirds of those with completion ALND reports persistent pain at long-term follow-up. Long-term morbidity after axillary staging after NACT require deeper understanding and should be considered in clinical decision-making.