Targeted axillary dissection and removing the clipped node

Targeted axillary dissection is an operation on the armpit used for people whose lymph nodes contained cancer at diagnosis and who then had chemotherapy or other treatment before surgery. Its aim is to check the armpit accurately while removing as few nodes as possible. At diagnosis, the node proven to contain cancer by needle biopsy is marked with a tiny clip or marker. After treatment, if the nodes look normal on examination and ultrasound, the surgeon removes two things: the sentinel nodes, found with a tracer, a dye or both, and the clipped node, found with a wire, a small seed or another localisation method placed shortly before or during surgery. Often the clipped node turns out to be one of the sentinel nodes, but not always. An X-ray of the removed tissue confirms the clip has been taken out. The pathologist then examines all removed nodes. Removing the node that definitely had cancer greatly improves the accuracy compared with sentinel node biopsy alone after chemotherapy. If no cancer remains in any removed node, most people can avoid full axillary clearance and its higher risk of arm swelling, usually going on to radiotherapy. If cancer remains, further armpit surgery or radiotherapy is typically recommended. Not every centre offers every localisation method, but the principle is widely used.

It follows chemotherapy first

It suits people with node-positive cancer that responded to treatment.

Two targets are removed

The sentinel nodes and the clipped node that had cancer.

It can spare full clearance

Clear results often mean no further node surgery.

Targeted axillary dissection is a real advance, but it is not perfect.

Cancer can still be missed

The chance is lower than with sentinel node biopsy alone after chemotherapy, but a small amount of cancer may remain in other nodes.

The clip is occasionally not retrieved

Sometimes the clip moves or cannot be seen. The surgeon may then remove more nodes to be thorough.

Extra procedures are involved

Placing a clip and later a wire or seed means additional visits to radiology.

What this page cannot tell you

It cannot say whether you qualify. That depends on how many nodes were affected and how they responded.

Recovery is usually similar to sentinel node biopsy and much easier than full clearance.

The wound

Expect a small armpit scar, some soreness and possibly a drain if the breast operation needs one.

Numbness and stiffness

Mild numbness of the inner arm and a tight feeling are common and usually improve over weeks to months.

Arm care

Gentle shoulder exercises help movement return. Report any swelling, redness or a tight band under the skin to your team.