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Expanding indications for nanoparticle-assisted axillary staging in node-positive breast cancer after neoadjuvant therapy: a prospective cohort study

Year: 2025

Type: article

Abstract: BACKGROUND: The accuracy of sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC) remains controversial, particularly in cases with extensive nodal involvement (cN2-3). Our preliminary study demonstrated that nanoparticle-assisted axillary staging (NAAS) achieved excellent diagnostic performance with a false-negative rate (FNR) of 4.2% in node-positive breast cancer patients after NAC. This pilot study aimed to evaluate the potential indication expansion of NAAS to include patients across all pre-NAC clinical nodal stages (cN1-3 stages). METHODS: A prospective single-center study involving 509 patients with pre-NAC node-positive breast cancer was conducted from April 2021 to November 2024. After NAC, all patients underwent NAAS followed by axillary lymph node dissection. We evaluated the detection rate, mean number of identified nodes, FNR, negative predictive value, and accuracy of the NAAS. Subgroup analyses based on pre-NAC clinical nodal (cN) stages were performed using chi-square test or Fisher's exact test. RESULTS: Among the 509 eligible patients, 498 successfully underwent NAAS. The pretreatment clinical nodal stages were distributed as follows: 359 patients (70.53%) were cN1, 56 (11.00%) were cN2, and 94 (18.47%) were cN3. The overall axillary skip metastasis rate was only 3.54% (18/509). NAAS demonstrated an accuracy of 98.39% and FNR of 3.74%, outperforming standard dual-tracer SLNB, which had an accuracy of 96.02% and FNR of 9.74%. When stratified by pretreatment nodal status, NAAS showed FNRs of 2.11% in cN1, 5.00% in cN2, and 7.69% in cN3 breast cancer patients. CONCLUSION: NAAS exhibited excellent diagnostic performance after NAC. The incorporation of black-stained non-SLNs improved nodal retrieval and positive node detection. And patients with pre-NAC cN2-3 stages, like those with cN1 stage, may be potential candidates for axillary preservation applying NAAS.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000004409