Background:
Nodal ultrasound with needle biopsy of abnormal lymph nodes (LNs) helps to define the extent of disease prior to neoadjuvant chemotherapy (NAC) with clip placement to designate LNs with documented metastases. Node positive patients routinely undergo axillary lymphadenectomy. The use of sentinel lymph node dissection (SLND) to identify patients with eradication of nodal disease after NAC has been limited by its high false negative rate. Targeted Axillary Dissection (TAD), or removal of the LNs known to contain metastases (clipped LN) as well as SLNs, may provide more accurate assessment of pathologic response after NAC.

Material and Methods:
Patients were identified from IRB-approved prospective trials who had biopsy-confirmed axillary LN metastases with a clip placed in the sampled LN. The clipped LN was targeted preoperatively under US guidance by wire-localization or I125 radioactive seed placement. Surgeons removed the localized LN before completion axillary node dissection (ALND) and x- rayed the LN to confirm removal of clip/seed.

Result:
Seventeen patients were included: 2 had wire localization, and 15 had I125 seed placement. All had successful removal of the clipped LN. Nine patients underwent SLND in addition to removal of the clipped LN. Fourteen patients completed NAC before surgery. Five(36%) patients had residual LN disease: all had disease identified in the clipped LN.

Conclusion:
Axillary LNs containing clips can be localized and selectively removed to accomplish Targeted Axillary Dissection. This is technically possible after NAC, is easily performed with other axillary surgery such as SLN dissection, and has a low false negative rate.