• Sherko Kuemmel, Joerg Heil, Anna Rueland, Christine Seiberling, Hakima Harrach, Dorothea Schindowski, Juliane Lubitz, Karin Hellerhoff, Christine Ankel, Sven-Thomas Graßhoff, Petra Deuschle, Volker Hanf, Kerstin Belke, Peter Dall, Julia Dorn, Gabriele Kaltenecker, Thorsten Kuehn, Ulrike Beckmann, Jochem Potenberg, Jens-Uwe Blohmer, Athina Kostara, Elisabeth Breit, Johannes Holtschmidt, Eugen Traut, and Mattea Reinisch.
• Breast Unit, Kliniken Essen-Mitte, Essen, Germany.
• Ann. Surg. 2022 Nov 1; 276 (5): e553-e562.

ObjectiveThis study aimed to investigate the feasibility and accuracy of non-radioactive TLN biopsy and TAD in routine clinical practice.Background DataTAD involves TLN biopsy (TLNB) and sentinel lymph node biopsy and was recently introduced as a new standard for less invasive axillary staging in BC patients undergoing neoadjuvant systemic therapy (NST); however, clinical evidence is limited.MethodsThe SenTa study is a prospective registry study conducted at 50 centers. Patients with invasive BC who nderwent clip insertion into the most suspicious axillary lymph node were eligible. Axillary surgery was performed with or without sentinel lymph node biopsy, TLNB, and/or axillary lymph node dissection (ALND). Main endpoints were the detection rate and FNR of TLNB and TAD after NST.ResultsBetween 2017 and 2018, 548 consecutive BC patients underwent clip placement into biopsy-confirmed positive lymph nodes. After NST (n = 473), the clipped TLN was intraoperatively resected in 329 of 423 patients [77.8%, 95% confidence interval (CI): 74.0-82.0]. TAD was successful in 199 of 229 patients (detection rate: 86.9%, 95% CI: 81.8-91.0), the SLN and TLN were identical in 129 patient (64.8%). FNRs were 7.2% (8 of 111, 95% CI: 3.1-13.6) for TLNB followed by ALND (n = 203) and 4.3% (2 of 46, 95% CI: 0.5-14.8) for TAD followed by ALND (n = 77).ConclusionsThe SenTa study demonstrates the feasibility of TAD in a real-world cohort of BC patients. Our findings are of great importance for de-escalation of surgical strategies.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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