Selective radio-guided axillary dissection (SeRAD): A prospective cohort study

Background/Objective: In the staging of the axilla for clinically lymph node negative disease, sentinel lymph node biopsy (SLNB) has become the standard over the axillary lymph node dissection (ALND). In patients with T1-T2 invasive breast cancer, clinically node negative, and one or two metastatic sentinel lymph nodes, SLNB alone results in the same survival as ALND. Axillary selective radioguided dissection technique (SeRAD) is comparable to SLNB + four or five parasentinel lymph node dissection. The aim of our study is to compare SeRAD versus SLNB, in order to demonstrate that SeRAD reduces the rate of reoperation of patients (ALND). Methods: The technique we developed for Selective radioguided axillary dissection is based on the removal of sentinel lymph node together with four or five parasentinel lymph nodes. This removal is performed following lymphatic flow, guided by decreasing radioactivity highlighted with the aid of the gamma probe. Since June 2014 through May 2016, we operated for invasive breast cancer 75 patients by SLNB and 145 patients by SeRAD technique. The average age of the patients was 55 (range 25-84). Results: Of the 75 patients subjected to SLNB, 14 had metastatic sentinel lymph node, and in all 14 cases ALND was needed. Of the 145 patients subjected to SeRAD, viceversa, 25 had metastatic sentinel and/or parasentinel lymph node, but only in 5 cases ALND was needed. Conclusions: In our experience, Selective Radio-assisted Axillary Dissection (SeRAD) has revealed many advantages compared to ALND and SLNB: . It removes both the SLN and a variable number of parasentinel lymph nodes, sufficient for oncological staging. . This radio-assisted technique ensures the removal of the first lymph node that follows the lymphatic flow after the SLN (unlike the single first level lymphectomy, which cannot guarantee this) and allows its inclusion in the histologic specimen even in cases of "skip metastases". . It permits avoidance of the intraoperative histo-cytologic examination of the SLN, thus shortening operating times. . It permits avoidance of the need to re-operate the patient in the presence of unfavorable histologic results,thus avoiding unnecessary lymphectomies with all its related complications. . It reduces costs and surgical time, compared to more demolitive surgery. . The performance of SeRAD is technically much easier and faster than ALND. . It allows for shorter post-operative hospitalization periods (a post-operative stay of 1 or 2 days less) and is almost free of complications.