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

Gurleyik, Gunay; Aksu, Sibel Aydin; Aker, Fügen; Tekyol, Kübra Kaytaz; Tanrıkulu, Eda; Gürleyik, Emin

doi:10.4174/astr.2021.100.6.305

Cited by 7 publications

(6 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hartmann et al published a prospective single-center feasibility trial with discouraging results—the clipped node identification rate was only 70.8% (17/24 cases) and in 6 patients (6/30 cases) the procedure was not finished due to non-visible clip or problems with wire-guided implantation [ 25 ]. On the other hand, Gurleyik et al proved the feasibility and accuracy of this method by analyzing 64 patients and achieving an identification rate of 98.4% using clip localisation followed by wire-guided localisation [ 26 ]. Despite this, there are still disadvantages related to wire-guided localisation such as patient discomfort, wire dislocation or transection, and more difficult time management before the surgery.…”

Section: Discussionmentioning

confidence: 99%

Ideal marker for targeted axillary dissection (IMTAD): a prospective multicentre trial

Žatecký,

Coufal,

Zapletal

et al. 2023

World J Surg Onc

View full text Add to dashboard Cite

Background Targeted axillary dissection (TAD) is an established method for axillary staging in patients with breast cancer after neoadjuvant chemotherapy (NAC). TAD consists of sentinel lymph node biopsy and initially pathological lymph node excision, which must be marked by a reliable marker before NAC. Methods The IMTAD study is a prospective multicentre trial comparing three localisation markers for lymph node localisation (clip + iodine seed, magnetic seed, carbon suspension) facilitating subsequent surgical excision in the form of TAD. The primary outcome was to prospectively compare the reliability, accuracy, and safety according to complication rate during marker implantation and detection and marker dislodgement. Results One hundred eighty-nine patients were included in the study—in 135 patients clip + iodine seed was used, in 30 patients magnetic seed and in 24 patients carbon suspension. The complication rate during the marker implantation and detection were not statistically significant between individual markers (p = 0.263; p = 0.117). Marker dislodgement was reported in 4 patients with clip + iodine seed localisation (3.0%), dislodgement did not occur in other localisation methods (p = 0.999). The false-negativity of sentinel lymph node (SLN) was observed in 8 patients, the false-negativity of targeted lymph nodes (TLN) wasn´t observed at all, the false-negativity rate (FNR) from the subcohort of ypN + patients for SLN is 9.6% and for TLN 0.0%. Conclusion The IMTAD study indicated, that clip + iodine seed, magnetic seed and carbon suspension are statistically comparable in terms of complications during marker implantation and detection and marker dislodgement proving their safety, accuracy, and reliability in TAD. The study confirmed, that the FNR of the TLN was lower than the FNR of the SLN proving that the TLN is a better marker for axillary lymph node status after NAC. Trial registration NCT04580251. Name of registry: Clinicaltrials.gov. Date of registration: 8.10.2020.

show abstract

Section: Discussionmentioning

confidence: 99%

Ideal marker for targeted axillary dissection (IMTAD): a prospective multicentre trial

Žatecký,

Coufal,

Zapletal

et al. 2023

World J Surg Onc

View full text Add to dashboard Cite

show abstract

“… 12 , 21 , 27 With coil and hook-wire combination, the reported IR of the MLN is 70.8-98.4% in four series with 23-64 patients. 20 , 26 , 29 , 30 One of these studies, however, excluded patients with nonidentification on the preoperative US, and the reported IR of 95.7% may be overestimated. 29 In a different study reporting on TAD with coil and ink marking on the axillary skin, the IR was 84%.…”

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

“…However, if the clip was not clearly visualized, an attempt was made to place another clip close to the first marker and patients in which the CN could not be localized by imaging studies were excluded, which did not happen in our study and may explain our lower CNB IR. Non-recovery of the CN may also have been due to clip dislodgement during SLN/CN dissection [ 22 , 24 ], since in one of our patients the clip was found inside a seroma on a post-surgery ultrasound.…”

Section: Discussionmentioning

confidence: 99%

“…Presurgical ultrasound-guided wire localization of the CN had high IR in some studies [ 9 , 20 , 24 ], but results are not always satisfactory [ 21 ], it requires an additional invasive procedure; displacement and discomfort are possible, and some radiologists are concerned with the proximity to axillary vessels [ 22 , 25 ]. Preoperative localization of the CN with seeds [ 13 ] or ink [ 26 ] may also improve removal of the CN.…”

Section: Discussionmentioning

confidence: 99%

“…[ 33 ] found a negative predictive value up to 97% for TAD: when nodal pCR is predicted, residual disease is missed in few patients. Several studies supported the combination of SNB with CNB [ 1 , 24 , 33 ]. The added value of SNB in the TAD procedure was also proved by our results, since three cases with a positive ALND specimen were only detected by SNB; in six cases with ineffective CNB, SNB was successful in staging the axilla; and even if it is not possible to localize the CN, we may surgically recover it as a SLN [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2022

View full text Add to dashboard Cite

Background Targeted axillary dissection (TAD) combines sentinel node biopsy (SNB) with the removal of the previously marked metastatic node. TAD is a promising concept for axillary restaging in node-positive breast cancer patients with pathological complete response (pCR) to neoadjuvant therapy (NAT). We aimed to evaluate TAD feasibility in this context. Methods A prospective observational study was conducted in biopsy-confirmed cN1 patients. The removal of the clipped node (CN) was guided by intraoperative ultrasound. SNB used indocyanine green and patent blue V dye. If the CN or sentinel lymph nodes (SLN) had any metastatic foci, or the TAD procedure was unsuccessful, the patient underwent axillary lymph node dissection (ALND). Results Thirty-seven patients were included. TAD and SNB identification rates were 97.3%. Every retrieved CN was also a SLN. At the individual level, SNB identification rate was 89.2% with indocyanine green and 85.5% with patent blue V dye. The CN identification rate was 81.1%, being higher when the CN was localized on the intraoperative ultrasound (84.4% vs 60.0%). Nodal pCR was achieved by 54.1% of our patients and was more frequent in HER2-positive and triple-negative tumors ( p = 0.039). Nineteen patients were spared from ALND. Conclusion TAD with intraoperative ultrasound-guided excision of the CN and SNB with indocyanine green and patent blue V dye is a feasible concept to identify patients without axillary residual disease after NAT, that can be spared from ALND, although the need for marking the biopsied node should be further investigated.

show abstract

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

Cited by 7 publications

References 30 publications

Ideal marker for targeted axillary dissection (IMTAD): a prospective multicentre trial

Ideal marker for targeted axillary dissection (IMTAD): a prospective multicentre trial

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

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

Contact Info

Product

Resources

About