Targeted Removal of Axillary Lymph Nodes After Carbon Marking in Patients with Breast Cancer Treated with Primary Chemotherapy

Hartmann, Steffi; Stachs, Angrit; Kühn, Thorsten; Boniface, Jana de; Banys‐Paluchowski, Maggie; Reimer, Toralf

doi:10.1055/a-1471-4234

Cited by 6 publications

(8 citation statements)

References 27 publications

(60 reference statements)

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“…The procedure is performed at the time of LN biopsy by injecting a charcoal suspension into the cortical of the suspected LN under ultrasound guidance. Immediately after injection, the charcoal particles are visible with a hyperechoic halo around the LN [ 50 ]. The black-marked perinodal tissues are visually localized intraoperatively.…”

Section: Axillary Localization Techniquesmentioning

confidence: 99%

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Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know

Paola¹,

Mazzotta

Conti

et al. 2023

Cancers

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Targeted axillary dissection (TAD) is an axillary staging technique after NACT that involves the removal of biopsy-proven metastatic lymph nodes in addition to sentinel lymph node biopsy (SLNB). This technique avoids the morbidity of traditional axillary lymph node dissection and has shown a lower false-negative rate than SLNB alone. Therefore, marking positive axillary lymph nodes before NACT is critical in order to locate and remove them in the subsequent surgery. Current localization methods include clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive tracer-based localizers, magnetic seeds, radar reflectors, and radiofrequency identification devices. The aim of this paper is to illustrate the management of axillary lymph nodes based on current guidelines and explain the features of axillary lymph node markers, with relative advantages and disadvantages.

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Section: Axillary Localization Techniquesmentioning

confidence: 99%

“…In these patients, there may be other pigmented ALN resulting from the drainage of ink from skin tattoos. The distinction may be allowed by the fact that usually perinodal tissue is pigmented only in iatrogenic LN tattooing [ 50 ].…”

Section: Axillary Localization Techniquesmentioning

confidence: 99%

Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know

Paola¹,

Mazzotta

Conti

et al. 2023

Cancers

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“…Besides clip marking, magnetic seeds and carbon suspension were also used to a relevant extent. Data from several prospective studies are available for tattooing the TLN with carbon, demonstrating high detection rates of consistently greater than 90 % [21]. In the largest of these studies, the multicenter TATTOO trial, a DR for the TLN of 93.6 % was determined in 110 cases.…”

Section: Parametersmentioning

confidence: 99%

Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany

Hartmann

Kühn

Hauptmann

et al. 2022

Geburtshilfe Frauenheilkd

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Introduction To date, the optimal axillary staging procedure for initially node-positive breast carcinoma patients after neoadjuvant chemotherapy (NACT) has been unclear. The aim of the AXSANA study is to prospectively compare different surgical staging techniques with respect to the oncological outcome and quality of life for the patients. Little is known about current clinical practice in Germany. Material and Methods In this paper we analyzed data from patients enrolled in the AXSANA study at German study sites from June 2020 to March 2022. Results During the period under investigation, 1135 patients were recruited at 143 study sites. More than three suspicious lymph nodes were initially found in 22% of patients. The target lymph node (TLN) was marked in 64% of cases. This was done with clips/coils in 83% of patients, with magnetic seeds or carbon suspension in 8% each, and with a radar marker in 1% of patients. After NACT, targeted axillary dissection (TAD) or axillary lymphadenectomy (ALND) were each planned in 48% of patients, and sentinel lymph node biopsy alone (SLNB) in 2%. Clinically, the nodal status after NACT was found to be unremarkable in 65% of cases. Histological lymph node status was correctly assessed by palpation in 65% of patients and by sonography in 69% of patients. Conclusion At the German AXSANA study sites, TAD and ALND are currently used as the most common surgical staging procedures after NACT in initially node-positive breast cancer patients. The TLN is marked with various markers prior to NACT. Given the inadequate accuracy of clinical assessment of axillary lymph node status after NACT, it should be questioned whether axillary dissection after NACT should be performed based on clinical assessment of nodal status alone.

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“…Außer der Clipmarkierung wurden auch magnetische Seeds und Kohlenstoffsuspension in relevantem Umfang verwendet. Für die Tätowierung des TLN mit Kohlenstoff liegen Daten aus mehreren prospektiven Studien vor, welche hohe Detektionsraten von einheitlich über 90 % belegen [21]. In der größten dieser Studien, der multizentrischen TATTOO-Studie, wurde für 110 Fälle eine DR für den TLN von 93,6 % ermittelt.…”

Section: Parameterunclassified

Axillastaging nach neoadjuvanter Chemotherapie bei initial nodal positivem Mammakarzinom in Deutschland

Hartmann

Kühn

Hauptmann

et al. 2022

TumorDiagnostik & Therapie

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Zusammenfassung Einleitung Das optimale axilläre Stagingverfahren für initial nodal positive MammakarzinompatientInnen nach neoadjuvanter Chemotherapie (NACT) ist bislang unklar. Die AXSANA-Studie wird mit dem Ziel durchgeführt, die verschiedenen operativen Stagingtechniken hinsichtlich ihres onkologischen Outcomes und der Lebensqualität prospektiv miteinander zu vergleichen. Über die aktuelle klinische Praxis in Deutschland ist wenig bekannt. Material und Methoden Die Daten der von Juni 2020 bis März 2022 an deutschen Studienzentren in die AXSANA-Studie aufgenommenen PatientInnen wurden analysiert. Ergebnisse Im Untersuchungszeitraum wurden 1135 PatientInnen an 143 Studienstandorten rekrutiert. Bei 22 % der PatientInnen fanden sich initial mehr als 3 suspekte Lymphknoten. In 64 % der Fälle wurde der Target-Lymphknoten (TLN) markiert. Dabei erfolgte die Markierung bei 83 % der PatientInnen mit Clips/Coils, bei je 8 % mit magnetischen Seeds oder Kohlenstoffsuspension und bei 1 % mit einem Radarmarker. Bei jeweils 48 % der PatientInnen wurde nach NACT eine Targeted Axillary Dissection (TAD) oder eine axilläre Lymphonodektomie (ALND) geplant, bei 2 % eine alleinige Sentinel-Lymphknoten-Biopsie (SLNB). Klinisch wurde der Nodalstatus nach NACT in 65 % der Fälle als unauffällig beurteilt. Bei 65 % der Frauen wurde der histologische Lymphknotenstatus durch die Palpation und bei 69 % der PatientInnen durch die Sonografie korrekt erfasst. Schlussfolgerung An den deutschen AXSANA-Studienzentren werden derzeit die TAD und die ALND als häufigste operative Stagingverfahren nach NACT bei primär nodal positiven MammakarzinompatientInnen durchgeführt, wobei die Markierung des TLN vor NACT mit verschiedenen Markern erfolgt. Aufgrund der ungenügenden Genauigkeit der klinischen Beurteilung des axillären Lymphknotenstatus nach NACT sollte kritisch hinterfragt werden, ob eine Axilladissektion nach NACT auf der Grundlage einer alleinigen klinischen Bewertung des Nodalstatus erfolgen sollte.

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Targeted Removal of Axillary Lymph Nodes After Carbon Marking in Patients with Breast Cancer Treated with Primary Chemotherapy

Cited by 6 publications

References 27 publications

Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know

Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know

Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany

Axillastaging nach neoadjuvanter Chemotherapie bei initial nodal positivem Mammakarzinom in Deutschland

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