Oncological outcomes of selective axillary dissection with 4% carbon marking.

INTRODUCTION

The use of axillary marking prior to Neoadjuvant Systemic Therapy (NST) is a controversial matter regarding patients with positive Lymph Nodes (LN). Several methods were tested to make possible the decrease of false negative rate in comparison to sentinel lymph node adding more accuracy to the results. This study aims to evaluate the oncological outcomes in patients who had undergone selective axillary dissection with 4% carbon marking before TSN.

METHODS

A prospective study was performed with cT1-T4, cN1-N2 breast cancer patients classified as suspected LNs undergoing concomitant 4% carbon marking. After TSN, targeted LNs were identified and resected associated to the sentinel lymph node (SLN) biopsy. The oncological outcomes pointed out were overall survival (OS), causespecific survival (CSS), distant disease-free survival (DDFS), axillary recurrence (AR) and local recurrence (LR).

RESULTS

A total of 168 patients were evaluated for a median period of 49 months. The axillary emptying was reached in 89 (50.6%) cases. Five of 168 patients (2.9%) had axillary recurrence (AR). There was a significant link between axillary emptying and AR (0 vs. 6% p = 0.012). The DDFS was 140/168 (83.3%), OS 158/168 (94%) and CSS 158/163 (96.9%).

CONCLUSION

The use of carbon marking in selective axillary dissection is a reliable low-cost method with simple execution. Among the oncological outcomes AR may not be considered for post downstaging axillary evaluation analysis since it is a rare event and not necessarily related to OS or DDFS.