Lymph node wire localization post-chemotherapy: Towards improving the false negative sentinel lymph node biopsy rate in breast cancer patients

Dashevsky, Brittany Z.; Altman, Ashley; Abé, Hiroyuki; Jaskowiak, Nora; Bao, Jean; Schacht, David; Sheth, Deepa; Kulkarni, Kirti

doi:10.1016/j.clinimag.2017.10.003

Cited by 17 publications

(12 citation statements)

References 27 publications

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“…Most other localization techniques using intraoperative clip removal confirmation reported reasonable to high identification rates. Hookwire localization, radioactive iodine-125 seed localization, or intraoperative ultrasound-guided surgery resulted in intraoperative identification (node with clip) rates of 71–97% [24, 25, 27, 28], 97% [13], or 96% [23], respectively.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of radioguided occult lesion localization of clip-marked lymph nodes for tailored axillary treatment in breast cancer patients treated with neoadjuvant systemic therapy

et al. 2019

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BackgroundSelective removal of initially tumor-positive axillary lymph nodes in breast cancer patients who underwent neoadjuvant systemic treatment (NST) improves the accuracy of nodal staging and provides the opportunity for more tailored axillary treatment. This study evaluated whether radioguided occult lesion localization (ROLL) of clip-marked lymph nodes is feasible in clinical practice.MethodsPrior to NST, a clip marker was placed inside a proven tumor-positive lymph node in all breast cancer patients (cTis-4N1-3 M0). After NST, technetium-99m-labeled macroaggregated albumin was injected in the clip-marked lymph nodes. The next day, these ROLL-marked nodes were selectively removed at surgery to evaluate the pathological response of the axilla.ResultsThirty-seven patients (38 axillae) underwent clip insertion. After NST, the clip was visible by ultrasound in 36 procedures (95%). In the other two patients, the ROLL-node injection was performed in a sonographically suspicious unclipped node (1), and near the clip under computed tomography guidance (1). Initial surgery successfully identified the ROLL-marked node with clip in 33 procedures (87%). Removed specimens in the other five procedures contained only the sonographically suspicious tumor-positive unclipped node (1), a node with signs of complete response but no clip (2), a clip without node (1), and tissue without node nor clip, and a second successful ROLL-node procedure was performed (1). Overall, 10 ROLL-marked nodes had no residual disease.ConclusionsThis study demonstrates that the ROLL procedure to identify clip-marked lymph nodes is feasible. This facilitates selective removal at surgery and may tailor axillary treatment in patients treated with NST.

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Section: Discussionmentioning

confidence: 99%

Feasibility of radioguided occult lesion localization of clip-marked lymph nodes for tailored axillary treatment in breast cancer patients treated with neoadjuvant systemic therapy

et al. 2019

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“…TAB seems to be an effective method of restaging the axilla after NAC and has emerged as a new staging option in biopsy-proven node-positive patients who convert to node-negative after chemotherapy [ 3 4 5 9 ]. First of all, accurate pre-NAC marking of metastatic nodes is of paramount importance in identifying the correct nodes after NAC.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent series, IRs of SLN after NAC between 85% and 98% have been reported [ 10 11 12 13 19 20 ]. Previous studies reported that the combination of TAB with SLN excision increased IR to 100% [ 3 4 21 22 23 ]. Simons et al [ 24 ] reported good rates for SLN alone (87.8%), marked node alone (92.8%), and combination procedure (99.3%) when compared with our results of 87.5%, 98.4%, and 98.4%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the evaluation of nodal pathologic response to chemotherapy is a key factor for post-NAC axillary surgery. Previous studies on NAC have shown that rates of pathologic complete response (pCR) of axillary lymph nodes was more than 30% depending on molecular subtypes of the tumor [ 1 2 3 4 5 ]. Axillary restaging after NAC requires a specific approach with new techniques.…”

Section: Introductionmentioning

confidence: 99%

“…After NAC, the false-negative rate (FNR) of SLNB alone is high in breast cancer patients with nodal metastasis [ 7 8 ]. Marking clip, radioactive seeds, tattooing with activated charcoal, and wire placement have been used to localize cytologically proven metastatic node [ 4 5 9 10 11 12 13 ]. Targeted lymph node biopsy after NAC is strongly dependent on adequately marking initially positive nodes under US guidance.…”

Section: Introductionmentioning

confidence: 99%

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Targeted axillary biopsy and sentinel lymph node biopsy for axillary restaging after neoadjuvant chemotherapy

et al. 2021

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Purpose Accurate restaging of the axilla after neoadjuvant chemotherapy (NAC) is an important issue to ensure deescalating axillary surgery in patients with initial metastatic nodes. We aimed to present our results of targeted axillary biopsy (TAB) combined with sentinel lymph node biopsy (SLNB) for axillary restaging after NAC. Methods In 64 breast cancer patients who underwent NAC, biopsy-proven positive nodes were marked with clips before NAC, and ultrasound-guided wire localization of clip-marked nodes was performed after NAC. Patients underwent TAB and SLNB for post-NAC axilla restaging. Results Identification rates of post-NAC TAB and SLNB were 98.4% and 87.5%, respectively (P = 0.033). Histopathology revealed a nodal pathologic complete response (pCR) rate of 47% in which axillary lymph node dissection (ALND) was avoided. TAB alone and SLNB alone detected residual disease in 29 (85.3%) and 20 (58.8%) patients (P = 0.029), respectively. Whereas rates of up to 97% had been achieved with a combination of TAB and SLNB. The pCR rates after NAC were 64.3% for human epidermal growth factor receptor 2 positive and triple-negative tumors and 13.6% in luminal tumors (P = 0.0002). Conclusion Pathologic analysis following TAB combined with SLNB revealed the pCR rates to NAC in a considerable number of patients that provided de-escalation of axillary surgery. A combination of SLNB and TAB was found to be an accurate procedure in establishing residual nodal disease. This combined procedure in patients with initially positive nodes was a reliable method for post-NAC axillary restaging.

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Management of the Axilla after Neoadjuvant Systemic Therapy

Stankowski-Drengler

Neuman

2020

Curr. Treat. Options in Oncol.

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Lymph node wire localization post-chemotherapy: Towards improving the false negative sentinel lymph node biopsy rate in breast cancer patients

Cited by 17 publications

References 27 publications

Feasibility of radioguided occult lesion localization of clip-marked lymph nodes for tailored axillary treatment in breast cancer patients treated with neoadjuvant systemic therapy

Feasibility of radioguided occult lesion localization of clip-marked lymph nodes for tailored axillary treatment in breast cancer patients treated with neoadjuvant systemic therapy

Targeted axillary biopsy and sentinel lymph node biopsy for axillary restaging after neoadjuvant chemotherapy

Management of the Axilla after Neoadjuvant Systemic Therapy

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