Delayed Sentinel Lymph Node Dissection in Patients with a Preoperative Diagnosis of Ductal Cancer In Situ by Preoperative Injection with Superparamagnetic Iron Oxide (SPIO) Nanoparticles: The SentiNot Study

Karakatsanis, Andreas; Eriksson, Staffan; Pistioli, Lida; Bagge, Roger Olofsson; Nagy, Gyula Richárd; Man, Vivian; Kwong, Ava; Wärnberg, Fredrik; Mohammed, I.; Hersi, Abdi Fatah; Jazrawi, Allan; Olofsson, Helena; Stålberg, Peter

doi:10.1245/s10434-022-13064-0

Cited by 23 publications

(19 citation statements)

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“…The median magnetic count was lower for ‘all SLN’, but not for the ‘first SLN’, and the values allowed for easy detection. These data not only corroborate previous reports and meta-analyses regarding SPIO as a tracer for SLN after PST 1 , 20 but suggest that the concept of delayed SLND through a wide time frame between SPIO administration and SLND, introduced in the SentiNot study 2 , 3 , can be applicable in the setting of PST, facilitating logistics and potentially enhancing axillary mapping.…”

Section: Discussionsupporting

confidence: 87%

“…Moreover, SPIO provide the possibility for delayed SLND, as demonstrated in the SentiNot study. In that study, SLND using SPIO was still feasible weeks after primary breast surgery for ductal carcinoma in situ , in the cases where specimen pathology demonstrated invasive cancer 2 , 3 . However, the role of SPIO for SLND after primary systemic therapy (PST) has not been extensively investigated.…”

Section: Introductionmentioning

confidence: 94%

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Magnetically guided surgery after primary systemic therapy for breast cancer: implications for enhanced axillary mapping

Pantiora,

Eriksson,

Wärnberg

et al. 2024

British Journal of Surgery

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Background Superparamagnetic iron nanoparticles perform comparably to radioisotope ± blue dye for sentinel lymph node detection in breast cancer, even when injected up to 8 weeks before surgery. Using superparamagnetic iron nanoparticles for sentinel lymph node detection after primary systemic therapy, and the maximum time frame of superparamagnetic iron nanoparticle administration have not been investigated. Methods This cohort study included cN0/1-to-ycN0 patients undergoing sentinel lymph node detection or targeted axillary dissection. All patients received superparamagnetic iron nanoparticles either before primary systemic therapy or before surgery, and radioisotope on the day of surgery. Results For 113 patients analysed, superparamagnetic iron nanoparticles were injected a median of 3 (range 0–248) days before surgery, with a 97.4% detection rate compared with 91.2% for radioisotope (P = 0.057). Concordance for radioisotope was 97.1% and this was not affected by timing of superparamagnetic iron nanoparticle injection (Kendall’s tau 0.027; P = 0.746). The median sentinel lymph node yield was 3 (interquartile range (i.q.r.) 2–3) for superparamagnetic iron nanoparticles and 2 (i.q.r. 2–3) for radioisotope (P < 0.001). In targeted axillary dissection, detection was 100% for superparamagnetic iron nanoparticles and 81.8% for radioisotope (P = 0.124). The index node was magnetic in 93.9% and radioactive in 66.7% (P = 0.007), an outcome that was not affected by any factors. For patients with metastases, superparamagnetic iron nanoparticle detection was 100% and radioisotope-based detection was 84.2% (P = 0.083), with superparamagnetic iron nanoparticles detecting more metastatic sentinel lymph nodes (median of 1 (i.q.r. 1–2) for superparamagnetic iron nanoparticles compared with a median of 1 (i.q.r. 0–1) for radioisotope; P = 0.005). Conclusion Injection before primary systemic therapy is feasible and does not affect concordance with radioisotope. Superparamagnetic iron nanoparticles perform comparably to radioisotope, but detect more sentinel lymph nodes and have a higher rate of detection of metastatic sentinel lymph nodes.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 94%

Magnetically guided surgery after primary systemic therapy for breast cancer: implications for enhanced axillary mapping

Pantiora,

Eriksson,

Wärnberg

et al. 2024

British Journal of Surgery

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“…They reported that the technical success rate of repeat SLNB, although not statistically significant, was higher in the primary mastectomy group (67.7%) than in the primary lumpectomy group (59.7%) ( p = 0.050) and significantly higher in the primary no-axillary procedure group (84.9%) than in the primary SLNB group (75.7%) ( p < 0.001). Karakatsanis et al [ 33 ] reported that using nanoparticles to mark the SLN allows for accurate delayed SLNB, if warranted. Hence, axillary surgery in DCIS may be necessary in cases of diagnostic upgrading; however, unnecessary axillary surgery can be avoided by delaying SLNB after the final diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes Based on Axillary Surgery in Ductal Carcinoma In Situ: A Nationwide Study From the Korean Breast Cancer Society

Kim,

Woo,

Lee

et al. 2024

J Breast Cancer

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Purpose In total mastectomy (TM), sentinel lymph node biopsy (SLNB) is recommended but can be omitted for breast-conserving surgery (BCS) in patients with ductal carcinoma in situ (DCIS). However, concerns regarding SLNB-related complications and their impact on quality of life exist. Consequently, further research is required to evaluate the role of axillary surgeries, including SLNB, in the treatment of TM. We aimed to explore the clinicopathological factors and outcomes associated with axillary surgery in patients with a final diagnosis of pure DCIS who underwent BCS or TM. Methods We retrospectively analyzed large-scale data from the Korean Breast Cancer Society registration database, highlighting on patients diagnosed with pure DCIS who underwent surgery and were categorized into two groups: BCS and TM. Patients were further categorized into surgery and non-surgery groups according to their axillary surgery status. The analysis compared clinicopathological factors and outcomes according to axillary surgery status between the BCS and TM groups. Results Among 18,196 patients who underwent surgery for DCIS between 1981 and 2022, 11,872 underwent BCS and 6,324 underwent TM. Both groups leaned towards axillary surgery more frequently for large tumors. In the BCS group, clinical lymph node status was associated with axillary surgery (odds ratio, 11.101; p = 0.003). However, in the TM group, no significant differences in these factors were observed. Survival rates did not vary between groups according to axillary surgery performance. Conclusion The decision to perform axillary surgery in patients with a final diagnosis of pure DCIS does not affect the prognosis, regardless of the breast surgical method. Furthermore, regardless of the breast surgical method, axillary surgery, including SLNB, should be considered for high-risk patients, such as those with large tumors. This may reduce unnecessary axillary surgery and enhance the patients’ quality of life.

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“…Although there have been reports of successful and technically feasible SLNB after mastectomy, index surgery is the best chance to assess axillary lymph nodes due to the disruption of lymphatic channels [ 18 , 21 ]. Recently, the SentiNot trial showed that marking the SLN with superparamagnetic iron oxide in patients with a preoperative diagnosis of DCIS resulted in avoiding upfront SLNB in 78.3% of patients, with delayed SLNB being feasible and yielding high detection rates once the invasive disease was found [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

De-escalation of Sentinel Lymph Node Biopsy in Patients With Ductal Carcinoma In Situ

Abdulla¹,

Khalaf²

2023

Cureus

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IntroductionCurrent guidelines recommend that sentinel lymph node biopsy (SLNB) be performed in patients with ductal carcinoma in situ (DCIS) undergoing mastectomy, in patients for whom the location of excision may compromise future SLNB, or if there is a high suspicion or risk of upstaging to invasive cancer on final pathology. Whether axillary surgery should be performed in patients with DCIS remains controversial. Our study aimed to examine the factors associated with the upgrade of DCIS to invasive cancer on final pathology and sentinel lymph node (SLN) metastases to evaluate whether axillary surgery may be safely omitted in DCIS. MethodsPatients with a diagnosis of DCIS on core biopsy who underwent surgery with axillary staging between 2016 and 2022 were identified from our pathology database and retrospectively reviewed. Patients who underwent surgical management of DCIS without axillary staging and those treated for local recurrence were excluded. ResultsOut of 65 patients, 35.3% of patients were upstaged to the invasive disease on final pathology. 9.23% of cases had a positive SLNB. Predictive factors associated with upstaging to invasive cancer included palpable mass on clinical examination (P = 0.013), presence of a mass on preoperative imaging (P = 0.040), and estrogen receptor status (P = 0.036). ConclusionOur results support ongoing opportunities for the de-escalation of axillary surgery in patients with DCIS. In a subset of patients undergoing surgery for DCIS, SLNB may be omitted as the risk of upstaging to invasive cancer is low. Patients with a mass on clinical examination or imaging and negative estrogen receptor (ER) lesions have a higher risk of upstaging to invasive cancer, where a sentinel lymph node biopsy should be performed.

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Delayed Sentinel Lymph Node Dissection in Patients with a Preoperative Diagnosis of Ductal Cancer In Situ by Preoperative Injection with Superparamagnetic Iron Oxide (SPIO) Nanoparticles: The SentiNot Study

Cited by 23 publications

References 58 publications

Magnetically guided surgery after primary systemic therapy for breast cancer: implications for enhanced axillary mapping

Magnetically guided surgery after primary systemic therapy for breast cancer: implications for enhanced axillary mapping

Survival Outcomes Based on Axillary Surgery in Ductal Carcinoma In Situ: A Nationwide Study From the Korean Breast Cancer Society

De-escalation of Sentinel Lymph Node Biopsy in Patients With Ductal Carcinoma In Situ

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