SPECT/CT Lymphoscintigraphy Accurately Localizes Clipped and Sentinel Nodes After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer

Dilege, Ece; Çelik, Burak; Falay, Okan; Böge, Medine; Sucu, Serkan; Toprak, Safa; Ağcaoğlu, Orhan; Kapucuoğlu, Nilgün; Demirkol, Mehmet Onur

doi:10.1097/rlu.0000000000004669

Cited by 5 publications

(1 citation statement)

References 21 publications

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“…In three of five studies 52–54 , the clipped TLN was injected with 99m Tc-labelled macroaggregated albumin under ultrasound guidance 1 day before surgery. In the other two 55 , 56 , either 99m Tc-labelled Nanoscan tracer or 99m Tc-labelled nanocolloid was injected (peritumorally or periareolarly) to localize the SLN by single-photon emission CT (SPECT)/CT on the day of surgery or 1 day before, and to determine whether the clipped TLN was an SLN. If not, either 99m Tc-labelled Nanoscan tracer was injected into the clipped TLN, or a wire was placed under ultrasound guidance to enable excision of the clipped TLN.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of targeted axillary dissection in node-positive breast cancer treated with neoadjuvant systemic therapy: variation in type of marker and timing of placement

de Wild,

Koppert,

van Nijnatten

et al. 2024

British Journal of Surgery

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Background In node-positive (cN+) breast cancer treated with neoadjuvant systemic therapy, combining sentinel lymph node biopsy and targeted lymph node excision, that is targeted axillary dissection, increases accuracy. Targeted axillary dissection procedures differ in terms of the targeted lymph node excision technique. This systematic review aimed to provide an overview of targeted axillary dissection procedures regarding definitive marker type and timing of placement: before neoadjuvant systemic therapy (1-step procedure) or after neoadjuvant systemic therapy adjacent to a clip placed before the neoadjuvant therapy (2-step procedure). Methods PubMed and Embase were searched, to 4 July 2023, for RCTs, cohort studies, and case–control studies with at least 25 patients. Studies of targeted lymph node excision only (without sentinel lymph node biopsy), or where intraoperative localization of the targeted lymph node was not attempted, were excluded. For qualitative synthesis, studies were grouped by definitive marker and timing of placement. The targeted lymph node identification rate was reported. Study quality was assessed using a National Institutes of Health quality assessment tool. Results Of 277 unique records, 51 studies with a total of 4512 patients were included. Six definitive markers were identified: wire, 125I-labelled seed, 99mTc, (electro)magnetic/radiofrequency markers, black ink, and a clip. Fifteen studies evaluated one-step procedures, with the identification rate of the targeted lymph node at surgery varying from 8 of 13 to 47 of 47. Forty-one studies evaluated two-step procedures, with the identification rate of the clipped targeted lymph node on imaging after neoadjuvant systemic therapy varying from 49 to 100%, and the identification rate of the targeted lymph node at surgery from 17 of 24 to 100%. Most studies (40 of 51) were rated as being of fair quality. Conclusion Various targeted axillary dissection procedures are used in clinical practice. Owing to study heterogeneity, the optimal targeted lymph node excision technique in terms of identification rate and feasibility could not be determined. Two-step procedures are at risk of not identifying the clipped targeted lymph node on imaging after neoadjuvant systemic therapy.

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Section: Resultsmentioning

confidence: 99%

Systematic review of targeted axillary dissection in node-positive breast cancer treated with neoadjuvant systemic therapy: variation in type of marker and timing of placement

de Wild,

Koppert,

van Nijnatten

et al. 2024

British Journal of Surgery

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Combined analysis of the MF18‐02/MF18‐03 NEOSENTITURK studies: ypN‐positive disease does not necessitate axillary lymph node dissection in patients with breast cancer with a good response to neoadjuvant chemotherapy as long as radiotherapy is provided

Muslumanoglu,

Cabioglu,

Igci

et al. 2024

Cancer

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BackgroundThe omission of axillary lymph node dissection (ALND) remains controversial for patients with residual axillary disease after neoadjuvant chemotherapy (NAC), regardless of the residual burden. This study evaluated the oncologic safety and factors associated with outcomes in patients with residual axillary disease. These patients were treated solely with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD), without ALND, after NAC.MethodsA joint analysis of two different multicenter cohorts—the retrospective cohort registry MF18‐02 and the prospective observational cohort registry MF18‐03 (NCT04250129)—was conducted between January 2004 and August 2022. All patients received regional nodal irradiation.ResultsFive hundred and one patients with cT1‐4, N1‐3M0 disease who achieved a complete clinical response to NAC underwent either SLNB alone (n = 353) or TAD alone (n = 148). At a median follow‐up of 42 months, axillary and locoregional recurrence rates were 0.4% (n = 2) and 0.8% (n = 4). No significant difference was found in disease‐free survival (DFS) and disease‐specific survival (DSS) rates between patients undergoing TAD alone versus SLNB alone, those with breast positive versus negative pathologic complete response, SLN methodology, total metastatic LN of one versus ≥2, or metastasis types as isolated tumor cells with micrometastases versus macrometastases. In the multivariate analysis, patients with nonluminal pathology were more likely to have a worse DFS and DSS, respectively, without an increased axillary recurrence.ConclusionsThe omission of ALND can be safely considered for patients who achieve a complete clinical response after NAC, even if residual disease is detected by pathologic examination. Provided that adjuvant radiotherapy is administered, neither the SLNB method nor the number of excised LNs significantly affects oncologic outcomes.

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Identificación de ganglio centinela axilar no detectado en cáncer de mama tratado con quimioterapia neoadyuvante

García-Ruiz,

Martínez-Rodríguez,

Martínez-Amador

et al. 2024

Revista Española de Medicina Nuclear e Imagen Molecular

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SPECT/CT Lymphoscintigraphy Accurately Localizes Clipped and Sentinel Nodes After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer

Cited by 5 publications

References 21 publications

Systematic review of targeted axillary dissection in node-positive breast cancer treated with neoadjuvant systemic therapy: variation in type of marker and timing of placement

Systematic review of targeted axillary dissection in node-positive breast cancer treated with neoadjuvant systemic therapy: variation in type of marker and timing of placement

Combined analysis of the MF18‐02/MF18‐03 NEOSENTITURK studies: ypN‐positive disease does not necessitate axillary lymph node dissection in patients with breast cancer with a good response to neoadjuvant chemotherapy as long as radiotherapy is provided

Identificación de ganglio centinela axilar no detectado en cáncer de mama tratado con quimioterapia neoadyuvante

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