Initial experience with targeted axillary dissection after neoadjuvant therapy in breast cancer patients

Pinto, C. S.; Peleteiro, Bárbara; Pinto, Conceição; Osório, Filipa; Costa, Serban-Dan; Magalhães, André; Mora, Henrique; Amaral, J.; Gonçalves, Diana; Fougo, José Luís

doi:10.1007/s12282-022-01349-x

Cited by 9 publications

(6 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Subsequently, it was excised under visual guidance during surgery. In two studies 73 , 74 , the clipped TLN was localized and excised under intraoperative ultrasound (IOUS) guidance.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Subsequently, it was excised under visual guidance during surgery. In two studies 73 , 74 , the clipped TLN was localized and excised under intraoperative ultrasound (IOUS) guidance.…”

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

View full text Add to dashboard Cite

show abstract

“… 31 One study, including 37 patients, reported an IR of 81.1% for intraoperative US-guided MLN excision. 32 …”

Section: Discussionmentioning

confidence: 99%

Comparing Methods for Targeted Axillary Dissection in Breast Cancer Patients: A Nationwide, Retrospective Study

et al. 2023

View full text Add to dashboard Cite

Background Several techniques exist for performing targeted axillary dissection (TAD) after neoadjuvant chemotherapy with the removal of the sentinel node and a marked metastatic lymph node (LN). Two-step methods include coil-marking of the metastatic LN at diagnosis and re-marking with an intraoperatively identifiable marker before surgery. Because nondetection of the marked lymph node (MLN) warrants axillary clearance and many patients achieve axillary pathological complete response (ax-pCR), the success of TAD is crucial. We compare various two-step TAD methods in a Danish national cohort. Methods We included patients who received two-step TAD between January 1, 2016 and August 31, 2021. Patients were identified from the Danish Breast Cancer Group database and cross-checked with locally accessible lists. Data were extracted from the patient’s medical files. Results We included 543 patients. In 79.4%, preoperative, ultrasound-guided re-marking was possible. Nonidentification of the coil-marked LN was more likely in patients with ax-pCR. The second markers used were hook-wire, iodine seeds, or ink marking on the axillary skin. Of patients with successful secondary marking, the MLN identification rate (IR) was 91%, and the sentinel node (SN) IR was 95%. Marking with iodine seeds was significantly more successful than ink marking with an odds ratio of 5.34 (95% confidence interval 1.62-17.60). The success rate of the complete TAD with the removal of MLN and SN was 82.3%. Conclusions With two-step TAD, nonidentification of the coiled LN before surgery is frequent, especially in patients with ax-pCR. Despite successful remarking, the IR of the MLN at surgery is inferior to one-step TAD.

show abstract

“…In terms of the effectiveness of surgical treatment, this finding has no clinical significance, since it is already well established that only the stained lymph node(s) should be resected during sentinel lymph node biopsy in primary surgery for breast cancer [ 20 , 40 ]. In sentinel lymph node biopsy after neoadjuvant chemotherapy, the recommendation is to use double labeling and to resect at least 3 lymph nodes, to obtain a false negative rate below 10% [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…The application of ICG associated with fluorescence has been tested for SLNB after neoadjuvant chemotherapy. A prospective study included patients with an initially clinically positive single axillary lymph node (cN1) and registered a lymph node detection rate of 89.2% with the modern dye versus 85.5% using traditional patent blue [ 42 ]. These data strengthen the versatility of the ICG in lymph node research.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the efficacy of using indocyanine green associated with fluorescence in sentinel lymph node biopsy

da Silva Sá,

Von Ah Rodrigues,

Bugalho

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Introduction Sentinel lymph node biopsy is the technique recommended for the axillary staging of patients with breast cancer in the initial stages without clinical axillary involvement. Three techniques are widely used globally to detect sentinel lymph nodes: patent blue, the radiopharmaceutical technetium 99 with gamma probe, and the combination of these two. Objectives To evaluate the sentinel lymph node detection rate with an innovative technique: indocyanine green (ICG) associated with fluorescence in breast cancer patients, and compare it with patent blue and a combination of patent blue and indocyanine green. Methods 99 patients were sequentially (not randomly) allocated into 3 arms with 33 patients submitted to sentinel lymph node techniques. One arm underwent patent blue dying, the other indocyanine green, and the third received a combination of both. The detection rates between arms were compared. Results The detection rate in identifying the sentinel lymph node was 78.8% with patent blue, 93.9% with indocyanine green, and 100% with the combination. Indocyanine green identified two sentinel nodes in 48.5% of patients; the other groups more commonly had only one node identified. The mean time to sentinel lymph node identification was 20.6 ± 10.7 SD (standard deviation) minutes among patients submitted to the patent blue dye, 8.6 ± 6.6 minutes in the indocyanine green arm, and 10 ± 8.9 minutes in the combined group (P<0.001; Student’s test). The mean surgery time was 69.4 ± 16.9; 55.1 ± 13.9; and 69.4 ± 19.3 minutes respectively (P<0.001; Student’s test). Conclusions The sentinel lymph node detection rate by fluorescence using indocyanine green was 93.9%, considered adequate. The rates using patent blue, indocyanine green, and patent blue plus indocyanine green (combined) were significantly different, and the indocyanine green alone is also acceptable, since it has a good performance in sentinel lymph node identification and it can avoid tattooing, with a 100% sentinel lymph node detection rate when combined with patent blue.

show abstract

Initial experience with targeted axillary dissection after neoadjuvant therapy in breast cancer patients

Cited by 9 publications

References 39 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

Comparing Methods for Targeted Axillary Dissection in Breast Cancer Patients: A Nationwide, Retrospective Study

Evaluation of the efficacy of using indocyanine green associated with fluorescence in sentinel lymph node biopsy

Contact Info

Product

Resources

About