{"entity":{"id":"targeted-axillary-dissection","kind":"term","name":"Targeted axillary dissection","aka":["TAD","clipped node removal","marked lymph node biopsy","MARI procedure"],"tldr":"When chemotherapy is given before surgery, the surgeon marks the lymph node that was known to contain cancer with a clip before treatment starts, then removes that exact node afterwards along with the sentinel nodes. It is the difference between missing leftover cancer one time in ten and one time in fifty.","summary":"ACOSOG Z1071 exposed the problem. Among 525 women with biopsy-proven node-positive disease who had two or more sentinel nodes removed after chemotherapy, the sentinel nodes were clear but the axillary clearance was not in 39 cases, a false-negative rate of 12.6 percent against a pre-specified acceptable threshold of 10 percent. Chemotherapy scars and reroutes lymphatics, so the node the tracer reaches after treatment is not reliably the node that was diseased before it.\n\nThe MD Anderson prospective study fixed it by marking the node. Placing a clip in the biopsied node before chemotherapy and localising it at surgery gave a false-negative rate of 4.2 percent for the clipped node alone (95 percent confidence interval 1.4 to 9.5), against 10.1 percent for sentinel node dissection alone (4.2 to 19.8); combining the two brought it to 1.4 percent (0.03 to 7.3, p=0.03), and formal targeted axillary dissection in 85 patients gave 2.0 percent. The finding that justifies the whole technique is that the clipped node was not retrieved as a sentinel node in 23 percent of patients, and six women had negative sentinel nodes but metastasis in the clipped node.\n\nLocalisation is by iodine-125 seed, radiofrequency or magnetic marker, wire, or carbon tattoo, depending on what the unit has. Dual tracer mapping and removing at least three sentinel nodes lower the false-negative rate further.\n\nWhat happens after a clear targeted axillary dissection is the live question. NSABP B-51 has answered the radiotherapy half: regional nodal irradiation adds nothing once the nodes are pathologically clear. ATNEC is asking the surgical half and is still recruiting.","asOf":"2026-09-25","links":[{"label":"Targeted axillary dissection (Journal of Clinical Oncology 2016)","url":"https://doi.org/10.1200/JCO.2015.64.0094"},{"label":"ACOSOG Z1071 (JAMA 2013)","url":"https://doi.org/10.1001/jama.2013.278932"}],"tags":[],"related":["sentinel-lymph-node-biopsy","lymphadenectomy","axillary-surgery-de-escalation","neoadjuvant-versus-adjuvant-breast"],"cancers":["breast-cancer","breast-hr-positive","breast-her2-positive","tnbc"],"sections":["surgery"],"technologies":["sentinel-node"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["acosog-z1071","targeted-axillary-dissection-md-anderson","atnec","nsabp-b51"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Procedures"},"route":"/terms/targeted-axillary-dissection/","neighbours":{"term":[{"id":"axillary-surgery-de-escalation","kind":"term","name":"Doing less to the armpit","route":"/terms/axillary-surgery-de-escalation/"},{"id":"neoadjuvant-versus-adjuvant-breast","kind":"term","name":"Drugs before or after the operation","route":"/terms/neoadjuvant-versus-adjuvant-breast/"},{"id":"lymphadenectomy","kind":"term","name":"Lymphadenectomy (lymph node dissection)","route":"/terms/lymphadenectomy/"},{"id":"sentinel-lymph-node-biopsy","kind":"term","name":"Sentinel node biopsy","route":"/terms/sentinel-lymph-node-biopsy/"}],"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"breast-her2-positive","kind":"cancer","name":"HER2-positive breast cancer","route":"/cancers/breast-her2-positive/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"sentinel-node","kind":"technology","name":"Sentinel lymph node biopsy","route":"/technologies/sentinel-node/"}],"trial":[{"id":"acosog-z1071","kind":"trial","name":"ACOSOG Z1071 (Alliance)","route":"/trials/acosog-z1071/"},{"id":"atnec","kind":"trial","name":"ATNEC","route":"/trials/atnec/"},{"id":"nsabp-b51","kind":"trial","name":"NSABP B-51 / RTOG 1304","route":"/trials/nsabp-b51/"},{"id":"targeted-axillary-dissection-md-anderson","kind":"trial","name":"Targeted axillary dissection (MD Anderson prospective study)","route":"/trials/targeted-axillary-dissection-md-anderson/"}]}}