Targeted Axillary Dissection (TAD) in Early-stage Node Positive Breast Cancer
RATIONALE: It is now standard for most breast cancer patients with 1-2 positive sentinel nodes to avoid completion node dissection when eligibility criteria from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial are met. The National Comprehensive Cancer Network (NCCN) recently proposed to extend this indication to patients that present with biopsy proven node positive disease if only 1 or 2 suspicious nodes are found on imaging, these positive nodes are not palpable clinically, and the other…
Conditions studied
Breast Cancer Female, Early-stage Breast Cancer, Lymph Node Metastases, Axillary Metastases, Sentinel Lymph Node
About this study
RATIONALE: It is now standard for most breast cancer patients with 1-2 positive sentinel nodes to avoid completion node dissection when eligibility criteria from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial are met. The National Comprehensive Cancer Network (NCCN) recently proposed to extend this indication to patients that present with biopsy proven node positive disease if only 1 or 2 suspicious nodes are found on imaging, these positive nodes are not palpable clinically, and the other eligibility criteria from the Z0011 study are otherwise met. However, this recommendation is based on an expert consensus and no study has yet confirmed the optimal method to stage the axilla in this patient population. PURPOSE: Evaluate the technical success rate and accuracy of sentinel node biopsy (SNB) and the potential benefits of clipping and removing the biopsy proven node using radioactive seed localisation (RSL) (SNB+RSL = Targeted Axillary Dissection (TAD)) in patients with biopsy proven positive nodes, limited nodal disease in imaging and clinically negative axillary examination.
Interventions
- Procedure: Targeted Axillary Dissection — Sentinel Node Biopsy (SNB; using Tc99 +/- Blue dye) + Radioactive Seed Localisation (RSL) of clipped node using I125 seed = Targeted Axillary Dissection (TAD)
- Diagnostic Test: Ultrasound of the axilla — Prospectively recorded preoperative ultrasound of the axilla. Number of suspicious nodes recorded. Biopsy and clipping of the positive node.
Primary outcomes
- Reduction in recommended completion node dissection rate (CND) with the use of Targeted Axillary Dissection (TAD) vs. Sentinel Node Biopsy (SNB) alone. (1 month)
Eligibility information
Study locations
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec H1T2M4 Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec H2X 3E4 Canada
- Jewish General Hospital, Montreal, Quebec H3T 1E2 Canada
Source: ClinicalTrials.gov. Record last refreshed by Varda Clinical: 2026-09-27.