Node-Positive Patients Treated with Neoadjuvant Chemotherapy Can Be Spared Axillary Lymph Node Dissection with Wireless Non-Radioactive Localizers

Laws, Alison; Dillon, Kayla; Kelly, Bridget B.; Kantor, Olga; Hughes, Kevin S.; Gadd, Michele A.; Smith, Barbara L.; Lamb, Leslie; Specht, Michelle C.

doi:10.1245/s10434-020-08902-y

Cited by 41 publications

(31 citation statements)

References 33 publications

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“…Data on this aspect lack detail in available studies but most authors report the placement of the marker into the "previously proven" node [44,48]. In contrast, marking of the suspicious lymph node immediately after the biopsy is reported by others [31,52]. Table 7 provides an overview of advantages and disadvantages of both strategies.…”

Section: When Should Lymph Nodes Be Marked?mentioning

confidence: 99%

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Banys‐Paluchowski

Gasparri

Boniface

et al. 2021

Cancers

101

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In the last two decades, surgical methods for axillary staging in breast cancer patients have become less extensive, and full axillary lymph node dissection (ALND) is confined to selected patients. In initially node-positive patients undergoing neoadjuvant chemotherapy, however, the optimal management remains unclear. Current guidelines vary widely, endorsing different strategies. We performed a literature review on axillary staging strategies and their place in international recommendations. This overview defines knowledge gaps associated with specific procedures, summarizes currently ongoing clinical trials that address these unsolved issues, and provides the rationale for further research. While some guidelines have already implemented surgical de-escalation, replacing ALND with, e.g., sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) in cN+ patients converting to clinical node negativity, others recommend ALND. Numerous techniques are in use for tagging lymph node metastasis, but many questions regarding the marking technique, i.e., the optimal time for marker placement and the number of marked nodes, remain unanswered. The optimal number of SLNs to be excised also remains a matter of debate. Data on oncological safety and quality of life following different staging procedures are lacking. These results provide the rationale for the multinational prospective cohort study AXSANA initiated by EUBREAST, which started enrollment in June 2020 and aims at recruiting 3000 patients in 20 countries (NCT04373655; Funded by AGO-B, Claudia von Schilling Foundation for Breast Cancer Research, AWOgyn, EndoMag, Mammotome, and MeritMedical).

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Section: When Should Lymph Nodes Be Marked?mentioning

confidence: 99%

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Banys‐Paluchowski

Gasparri

Boniface

et al. 2021

Cancers

101

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“…However, the tattooed node may not be identifiable intraoperatively due to migration or absorption of charcoal in some cases. Other localization techniques using Magseed or RFID Tags have successful removal rates of 94.6%-97% [19,20], but these are expensive techniques and not available worldwide.…”

Section: Discussionmentioning

confidence: 99%

“…The Targeted Axillary Dissection (TAD) procedure involves removing SLNs with the clipped node by localization with iodine-125 radioactive seeds and had an FNR of 2.0% [10]. Other labeling and localization techniques such as wire localization of clipped nodes [11][12][13][14][15], tattooing [16][17][18], and clipped node localization using Magseed or Radiofrequency Identification Tags (RFID) [19,20] are under investigation.…”

Section: Introductionmentioning

confidence: 99%

Axillary Evaluation with Targeted Axillary Dissection using Ultrasound-visible Clips after Neoadjuvant Chemotherapy for Patients with Node-Positive Breast Cancer

2022

J Surg

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Background: Targeted Axillary Dissection (TAD) can decrease the False-Negative Rate (FNR) of sentinel lymph node biopsy after Neoadjuvant Chemotherapy (NAC). This study aimed to investigate the accuracy of TAD using ultrasound-visible clips for axillary staging, with the secondary aims of assessing the ultrasound identification rate and localization technique of the clipped node.Methods: This prospective study was conducted using patients with clinically T1-3, N1, 2, M0 breast cancer undergoing NAC followed by surgery. For targeted lymph node biopsy, a Hydromark or a UltraCore Twirl clip was placed in a biopsyproven node. During the surgery, the clipped node was removed with sentinel lymph nodes and palpable nodes.Results: A total of 26 patients were enrolled. The median number of lymph nodes removed with TAD was four (range, 2-10). The FNR of TAD was 0% (0/16). Ultrasound identified the clipped node marked with the UltraCore Twirl in 100% (12/12) and with the Hydromark in 92.9% (13/14, p = ns) of the respective cases. Wire localization combined with dye injection successfully removed the node marked with the UltraCore Twirl in 100% (12/12), whereas the node marked with the Hydromark was removed by localization with fluorescence technique, wire-and-fluorescence technique, and wire-and-dye injection in 50% (1/2), 100% (2/2), and 80% (8/10) of the cases, respectively (p = ns).Conclusions: TAD predicted post-NAC axillary nodal status with an FNR of 0%. Labelling the positive node with a USvisible clip and localizing it with a wire and dye allowed successful TAD.

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“…Plecha et al [ 16 ] reported that the IR of wire-localized clipped nodes was 97% in 91 patients. If biopsy-proven positive nodes were marked before chemotherapy, IRs of more than 95% would have been reported [ 3 8 12 17 18 ].…”

Section: Discussionmentioning

confidence: 99%

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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Node-Positive Patients Treated with Neoadjuvant Chemotherapy Can Be Spared Axillary Lymph Node Dissection with Wireless Non-Radioactive Localizers

Cited by 41 publications

References 33 publications

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Surgical Management of the Axilla in Clinically Node-Positive Breast Cancer Patients Converting to Clinical Node Negativity through Neoadjuvant Chemotherapy: Current Status, Knowledge Gaps, and Rationale for the EUBREAST-03 AXSANA Study

Axillary Evaluation with Targeted Axillary Dissection using Ultrasound-visible Clips after Neoadjuvant Chemotherapy for Patients with Node-Positive Breast Cancer

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

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