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Axilla, Sentinel Lymph node, Pre-operative localization, Ink, Interventional ultrasonography
Background: Pre-operative localization options in the axilla are limited. This study aimed to explore the utility of pre-operative localization of axillary lymph nodes using tattoo ink with multidisciplinary correlations.
Methods: In this prospective, Institutional Review Board (IRB)-approved study, 19 lymph nodes in 17 patients underwent pre-operative localization with ultrasound-guided injection of Spot tattoo ink. The success rate of intraoperative identification of the tattooed node as well as the frequency in which the tattooed node was also a sentinel node were recorded. Radiologic, surgical and pathologic images were collected.
Results: Tattoo ink localization was successful in 16/17 (94.1%) of patients. Tattoo ink did not hinder pathologic evaluation in any cases but was taken up by additional adjacent nodes in 1/17 successful localizations (5.9%). Successful sentinel lymph node biopsy (SLNB) occurred in 13 patients in whom 14 lymph nodes underwent pre-operative tattoo ink localization. Nine of the 14 (64.2%) tattooed lymph nodes were also a sentinel node.
Conclusion: In this study, pre-operative localization of axillary lymph nodes with tattoo ink was highly successful In patients undergoing SLNB, a significant number of the tattooed nodes were not sentinel nodes (35.8%), suggesting the importance of targeted lymph node excision in addition to SLNB.
2. Wang Y, Dong H, Wu H, Zhang L, Yuan K, Chen H, et al. Improved false negative rate of axillary status using sentinel lymph node biopsy and ultrasound-suspicious lymph node sampling in patients with early breast cancer. BMC cancer. 2015;15(1):1-7.
3. Caudle AS, Yang WT, Mittendorf EA, Black DM, Hwang R, Hobbs B, et al. Selective surgical localization of axillary lymph nodes containing metastases in patients with breast cancer: a prospective feasibility trial. JAMA surgery. 2015;150(2):137-43.
4. Diego EJ, McAuliffe PF, Soran A, McGuire KP, Johnson RR, Bonaventura M, et al. Axillary staging after neoadjuvant chemotherapy for breast cancer: a pilot study combining sentinel lymph node biopsy with radioactive seed localization of pre-treatment positive axillary lymph nodes. Annals of surgical oncology. 2016;23(5):1549-53.
5. Greenwood HI, Wong JM, Mukhtar RA, Alvarado MD, Price ER. Feasibility of magnetic seeds for preoperative localization of axillary lymph nodes in breast cancer treatment. American Journal of Roentgenology. 2019;213(4): 953-7.
6. Janssen N, Nijkamp J, Alderliesten T, Loo C, Rutgers E, Sonke J, et al. Radioactive seed localization in breast cancer treatment. Journal of British Surgery. 2016;103(1):70-80.
7. Lowes S, Bell A, Milligan R, Amonkar S, Leaver A. Use of Hologic LOCalizer radiofrequency identification (RFID) tags to localise impalpable breast lesions and axillary nodes: experience of the first 150 cases in a UK breast unit. Clinical Radiology. 2020;75(12):942-9.
8. Allweis TM, Menes T, Rotbart N, Rapson Y, Cernik H, Bokov I, et al. Ultrasound guided tattooing of axillary lymph nodes in breast cancer patients prior to neoadjuvant therapy, and identification of tattooed nodes at the time of surgery. European Journal of Surgical Oncology. 2020;46(6):1041-5.
9. Choy N, Lipson J, Porter C, Ozawa M, Kieryn A, Pal S, et al. Initial results with preoperative tattooing of biopsied axillary lymph nodes and correlation to sentinel lymph nodes in breast cancer patients. Annals of surgical oncology. 2015;22(2):377-82.
10. Natsiopoulos I, Intzes S, Liappis T, Zarampoukas K, Zarampoukas T, Zacharopoulou V, et al. Axillary lymph node tattooing and targeted axillary dissection in breast cancer patients who presented as cN+ before neoadjuvant chemotherapy and became cN0 after treatment. Clinical breast cancer. 2019;19(3):208-15.
11. Patel R, MacKerricher W, Tsai J, Choy N, Lipson J, Ikeda D, et al. Pretreatment tattoo marking of suspicious axillary lymph nodes: reliability and correlation with sentinel lymph node. Annals of surgical oncology. 2019;26(8):2452-8.
12. Kim WH, Kim HJ, Jung JH, Park HY, Lee J, Kim WW, et al. Ultrasound-guided restaging and localization of axillary lymph nodes after neoadjuvant chemotherapy for guidance of axillary surgery in breast cancer patients: experience with activated charcoal. Annals of surgical oncology. 2018;25(2):494-500.
13. Kim WH, Kim HJ, Jung JH, Park HY, Lee J, Kim WW, et al. Ultrasound-guided fine-needle aspiration of non-palpable and suspicious axillary lymph nodes with subsequent removal after tattooing: false-negative results and concordance with sentinel lymph nodes. Ultrasound in medicine & biology. 2017;43(11):2576-81.
14. Kim WH, Kim HJ, Kim SH, Jung JH, Park HY, Lee J, et al. Ultrasound-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy with clip and activated charcoal in breast cancer patients: a feasibility study. BMC cancer. 2019;19(1):1-8.
15. Park S, Koo JS, Kim GM, Sohn J, Kim SI, Cho YU, et al. Feasibility of charcoal tattooing of cytology-proven metastatic axillary lymph node at diagnosis and sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients. Cancer research and treatment: official journal of Korean Cancer Association. 2018;50(3):801.
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