# Targeted axillary dissection (MD Anderson prospective study)

Source: https://onco.cc/trials/targeted-axillary-dissection-md-anderson/  
OnCo record `targeted-axillary-dissection-md-anderson` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The fix for the problem Z1071 exposed. If the surgeon puts a marker in the lymph node that was biopsied at diagnosis and then goes back for that exact node after chemotherapy, the chance of missing leftover cancer falls from about one in ten to about one in fifty.

## Summary

This prospective study enrolled 208 patients with biopsy-confirmed nodal metastases in whom a clip had been placed in the sampled node before treatment. After chemotherapy they had axillary surgery, and the pathology of the clipped node was compared with the rest. 191 went on to completion axillary clearance, and 120 of those (63 percent) had residual disease, so the false-negative rate could be measured.

The clipped node alone showed metastases in 115 patients, a false-negative rate of 4.2 percent (95 percent confidence interval 1.4 to 9.5). Sentinel node dissection alone, in the 118 patients who had both, gave 10.1 percent (4.2 to 19.8). Adding evaluation of the clipped node to sentinel node dissection brought it to 1.4 percent (0.03 to 7.3, p=0.03). In 85 patients who had formal targeted axillary dissection followed by clearance, the false-negative rate was 2.0 percent (one of fifty, 0.05 to 10.7).

The finding that explains why the technique is necessary is buried in the middle of the paper: the clipped node was not retrieved as a sentinel node in 23 percent of patients, 31 of 134, and six of those had negative sentinel nodes but metastasis in the clipped node. The node that was known to contain cancer is often not the node the tracer finds.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-25
- Also known as: TAD study; clipped node study
- Phase: observational
- Setting: Biopsy-confirmed node-positive breast cancer with a clip placed in the sampled node before chemotherapy: selective removal of the clipped node alongside sentinel node dissection, checked against completion axillary clearance
- Sponsor: University of Texas MD Anderson Cancer Center
- Enrolled: 208
- Result: Adding the clipped node to sentinel node dissection cut the false-negative rate from 10.1 to 1.4 percent (p=0.03); targeted axillary dissection gave 2.0 percent.
- Outcomes: False-negative rate after chemotherapy: Sentinel node dissection alone 10.1% vs Sentinel node dissection plus the clipped node 1.4% vs Targeted axillary dissection 2%
- Replication: Dual-tracer mapping with a minimum of three sentinel nodes reaches a similar false-negative rate in the Z1071 and SENTINA datasets; ATNEC is testing what to do when targeted axillary dissection is clear.

## Sources

- Targeted axillary dissection (Journal of Clinical Oncology 2016): https://doi.org/10.1200/JCO.2015.64.0094

## Connected records

- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- technologies: [Fluorescence-guided surgery](https://onco.cc/technologies/fluorescence-guided-surgery/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/)
- terms: [Drugs before or after the operation](https://onco.cc/terms/neoadjuvant-versus-adjuvant-breast/), [Sentinel node biopsy](https://onco.cc/terms/sentinel-lymph-node-biopsy/), [Targeted axillary dissection](https://onco.cc/terms/targeted-axillary-dissection/)
- trials: [ACOSOG Z1071 (Alliance)](https://onco.cc/trials/acosog-z1071/), [ATNEC](https://onco.cc/trials/atnec/)

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