Targeted axillary dissection in breast cancer patients: a systematic review and meta-analysis

Targeted axillary dissection (TAD) is an innovative approach for axillary staging in breast cancer patients with initially node-positive disease that converts to clinically node-negative status after neoadjuvant therapy. Optimal marking and localization techniques remain undetermined. This systematic review and meta-analysis searched PubMed, Scopus, Cochrane Library, and Web of Science through April 2025, including 59 observational studies on TAD (marked/clipped node removal plus sentinel lymph node biopsy) in such patients. Primary outcomes were identification rate, false-negative rate (FNR), concordance, and diagnostic accuracy. Using R software with random-effects models and logit transformation, TAD achieved a pooled identification rate of 95.1% (95% CI: 93.2%-96.5%). Pooled FNR was 6.37% (95% CI: 5.02%-8.04%; I² = 0.0%), with overall diagnostic accuracy of 94.68% (95% CI: 91.70%-96.63%). Targeted and sentinel nodes concorded in 73.34% (95% CI: 69.58%-76.79%). Subgroup analyses showed comparable performance across marking (clip, carbon, magnetic, radioactive seeds) and localization techniques (wire-guided, radioactive, magnetic, ultrasound-guided), with no significant differences. TAD offers high identification rates, low FNRs, reliable staging, and acceptable accuracy, with consistent results enabling implementation using locally available technologies.