Safe and transparent introduction and evaluation of targeted axillary dissection in patients with node-positive breast cancer undergoing primary surgery: International consensus process

February 18, 2026

Publications

>

Review

No

Safe and transparent introduction and evaluation of targeted axillary dissection in patients with node-positive breast cancer undergoing primary surgery: International consensus process

Publicated to: BJS OPEN. 9 (6): - 2025-12-01 9(6), DOI: 10.1093/bjsopen/zraf121

Authors:

Potter S; Mullan R; Cain H; St John ER; Barry P; Massanat Y; Harvey J; Fairhurst K; Morgan A; Perkins M; Mann GB; Lippey J; Cowan K; Blencowe N; McIntosh SA; Avery K; Baji P; Bhattacharya I; Cutress R; Culliford L; Dodwell D; Frost J; Harris J; Markham H; Marques E; Roberts K; Rees S; Aamer M; Abbott N; Abdelaziz Y; Abdelwahab K; Abdulla H; Abufkhaida B; Agrawal A; Ahmad Z; Ali Ahmed MS; Ahmed S; Saad SAL; Alhussini M; Alriyees L; Alshawi J; Aslam M; Attia M; Awaji K; Baban C; Bagué AH; Bajonero-Canonico P; Baştürk SA; Bibal F; Bolivar E; Bramley M; Brown V; Buldanli MZ; Canotilho R; Luna MIC; Carmichael AR; Caziuc A; Chan CW; Chand N; Chandrashekar M; Chaubey A; Chen S; Daskalova I; Dimitrov D; Dordea M; Douvetzemis S; Elahi M; Elder K; Elsberger B; Elzein S; Fanshawe A; Félix R; Fowler C; Gallini E; Gan J; Garg N; Georgescu R; Ghazali W; Ginghina O; Godden AR; Gomez-Quiñones O; Graham V; Gul MC; Hançerlioǧullari O; Harding-Mackean C; Hargreaves A; Harris G; Hartley F; Hassan I; Hayat S; Holcombe C; Horsnell J; Hubbard T; Hunter-Smith A; Ikram R; Irvine T; Irwin G; Isherwood J; Isik A; Islam S

[+]

Affiliations

Aberdeen Royal Infirmary - Author

Afyonkarahisar State Hospital - Author

Al-Quds University - Author

Altnagelvin Area Hospital - Author

Belfast Health and Social Care Trust - Author

Bristol Medical School - Author

Broomfield Hospital - Author

Cancer Center Tec 100 - Author

Castle Hill Hospital - Author

Centre Hospitalier Universitaire Yalgado Ouedraogo - Author

Clinica Quiron - Author

Countess of Chester Hospital NHS Foundation Trust - Author

Department of Surgery; St. Vincent's Hospital Melbourne; St. Vincent's Hospital Melbourne - Author

Dhaka Medical College and Hospital - Author

Dr Mohamed Aamer Clinic - Author

Dr. Faisal Masood Teaching Hospital - Author

Dr. Suhair Al Saad Medical Centre - Author

Edinburgh Breast Unit - Author

European Medical Center - Author

Faculty of Medicine - Author

Gloucestershire Hospitals NHS Foundation Trust - Author

Gülhane Eğitim ve Araştırma Hastanesi - Author

Hampshire Hospitals NHS Foundation Trust - Author

Hospital do Espírito Santo - Author

Independent Cancer Patients' Voice - Author

Instituto Mexicano del Seguro Social - Author

Instituto Português de Oncologia do Porto FG - Author

Institutul Oncologic Prof. Dr. Alexandru Trestioreanu Bucuresti - Author

Istanbul Medeniyet University - Author

KAT Hospital - Author

Katherine Cowan Consulting - Author

Khyber Medical College - Author

King Abdulaziz Medical City - Jeddah - Author

King Abdulaziz University Hospital - Author

Kingston and Richmond NHS Foundation Trust - Author

Krishna Surgical Center - Author

London North West University Healthcare NHS Trust - Author

Mansoura Oncology Center - Author

Mayo Hospital Lahore - Author

Medical University - Pleven - Author

Mid Cheshire Hospitals NHS Foundation Trust - Author

Milton Keynes University Hospitals - Author

Mures County Hospital - Author

NHS Highland - Author

North Tees and Hartlepool NHS Foundation Trust - Author

Northumbria Healthcare NHS Foundation Trust - Author

Portsmouth Hospitals University NHS Trust - Author

Portsmouth Hospitals University NHS Trust; University of Portsmouth - Author

Prince of Wales Hospital - Author

PUMHS - Author

Queen's University Belfast - Author

Regency Specialist Hospital - Author

Royal Liverpool University Hospital - Author

Royal Melbourne Hospital; Royal Women's Hospital, Carlton; Breast Cancer Trials; Department of Surgery - Author

Royal Surrey NHS Foundation Trust - Author

Royal United Hospital - Author

Salisbury District Hospital - Author

Shaikh Zayed Medical Complex - Author

Sociedad Venezolana de Cardiología - Author

Solis Breast Care and Surgery Centre - Author

Somerset Foundation Trust - Author

Southmead Hospital Bristol; North Bristol NHS Trust - Author

Southmead Hospital Bristol; The Newcastle Upon Tyne Hospitals NHS Foundation Trust - Author

St Vincent's University Hospital - Author

Swansea Bay University Health Board - Author

The Newcastle Upon Tyne Hospitals NHS Foundation Trust - Author

The Royal Marsden NHS Foundation Trust - Author

The University of Manchester - Author

Universitatea de Medicina si Farmacie Iuliu Hatieganu din Cluj-Napoca - Author

University Hospital Limerick - Author

University Hospital Southampton NHS Foundation Trust - Author

University Hospitals Derby and Burton - Author

University of Exeter - Author

University of Health Sciences - Author

University of Jeddah - Author

Uşak Training and Research Hospital - Author

Whipps Cross Hospital - Author

Abstract

Background Axillary node clearance is the current standard of care in patients with node-positive breast cancer undergoing primary surgery, despite a lack of evidence to demonstrate survival benefit and high rates of life-changing morbidity. Targeted axillary dissection (TAD) may be a safe alternative to axillary node clearance, but there is no agreement how primary TAD should be performed. TADPOLE-TOGETHER aimed to use international consensus methods to agree the key components of primary TAD to promote standardized introduction and evaluation of the technique within the TADPOLE trial. Methods A scoping review and key stakeholder interviews were used to generate a longlist of possible procedure steps for inclusion in the Delphi questionnaire. Two rounds of an international online survey were then used to agree the mandatory, optional, and prohibited steps of TAD, together with any standardization and training required. The final approach to primary TAD was agreed at an online consensus meeting. Results Thirteen potential steps of a TAD procedure were identified from the literature and expert interviews, together with information regarding standardization and training. Some 244 surgeons with global representation participated in the Round 1 survey, of whom 161 (66.0%) participated in Round 2. Seven mandatory steps of primary TAD, including localization and removal of the involved node, combined with a sentinel node biopsy, were agreed upon and ratified by 42 surgeons from the UK, Europe, and Asia who attended the consensus meeting. Conclusion Robust international consensus methods have been used to agree how primary TAD should be performed, promoting safe and transparent introduction and evaluation of the technique.

[+]

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal BJS OPEN due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2025, it was in position 19/314, thus managing to position itself as a Q1 (Primer Cuartil), in the category Surgery. Notably, the journal is positioned above the 90th percentile.

[+]

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Australia; Bahrain; Bangladesh; Bulgaria; Egypt; Gran Bretanya; Greece; India; Malaysia; Mexico; Pakistan; Palestine; Portugal; Russia; Saudi Arabia; Singapore; Turkey; United Kingdom; Venezuela.

[+]

Indexed in

License and Use

Altmetrics

Analysis of institutional authors

Share

Safe and transparent introduction and evaluation of targeted axillary dissection in patients with node-positive breast cancer undergoing primary surgery: International consensus process

Affiliations

Abstract

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

Leadership analysis of institutional authors

Indexed in

License and Use

Altmetrics

Analysis of institutional authors

Share

Safe and transparent introduction and evaluation of targeted axillary dissection in patients with node-positive breast cancer undergoing primary surgery: International consensus process

Affiliations

Abstract

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

Impact and social visibility

Leadership analysis of institutional authors