Tanir M Allweis1, Tehillah Menes2, Noa Rotbart3, Yael Rapson4, Hana Cernik5, Inna Bokov5, Judith Diment6, Ada Magen7, Orit Golan8, Noa Levi-Bendet9, Osnat Givon Madhala7, Ahuva Grubstein4. 1. Kaplan Medical Center, Dept of Surgery and Breast Health Center, Rehovot, Israel; Hadassah Hebrew University Medical School, Jerusalem, Israel. Electronic address: taniral@clalit.org.il. 2. Tel Aviv Sourasky Medical Center, Dept of Surgery, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Rabin Medical Center- Beilinson, Dept of Radiology, Petach Tikva, Israel. 4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Rabin Medical Center- Beilinson, Dept of Radiology, Petach Tikva, Israel. 5. Kaplan Medical Center, Dept of Radiology and Breast Health Center, Rehovot, Israel. 6. Kaplan Medical Center, Dept of Pathology, Rehovot, Israel. 7. Rabin Medical Center- Beilinson, Dept of Surgery, Petach Tikva, Israel. 8. Tel Aviv Sourasky Medical Center, Dept of Radiology, Tel Aviv, Israel. 9. Rabin Medical Center- Hasharon, Dept of Surgery, Petach Tikva, Israel.
Abstract
BACKGROUND: Breast cancer patients with lymph node (LN) metastases at diagnosis often undergo neoadjuvant therapy (NAT). Identification of a LN which regressed after NAT remains a challenge. OBJECTIVE: To evaluate marking of involved nodes by tattooing with carbon suspension, and identifying these nodes during surgery. METHODS: A small amount (0.2-0.5 ml) of carbon suspension was injected into one or two axillary LNs under ultrasound guidance at the time of LN biopsy or before or shortly after starting NAT for LN positive breast cancer. During surgery an attempt was made to identify and remove the tattooed LN as a separate specimen. All patients underwent sentinel LN mapping and biopsy and/or axillary LN dissection as mandated by their clinical status. RESULTS: Sixty three patients underwent tattooing of axillary LNs with no complications or adverse events. At surgery a tattooed node was identified in 60 patients (95%; 95% CI 87, 98). Of 56 patients who underwent sentinel mapping with Tc99, in 51 (91%; 95% CI 81, 96) at least one radioactive LN was identified. Of 50 patients in whom both radioactivity and tattoo were identified in axillary LNs, in 40 (80%; 95% CI 67, 89) LNs were radioactive and tattooed, however in 10 patients (20%; 95% CI 11, 33), the tattooed LN was not radioactive. CONCLUSIONS: Tattooing of axillary LNs is safe and easily performed. Tattooing was helpful in identifying the marked LN in the majority of cases. This technique helps to ensure that metastatic LNs are identified and removed at surgery after NAT.
BACKGROUND:Breast cancerpatients with lymph node (LN) metastases at diagnosis often undergo neoadjuvant therapy (NAT). Identification of a LN which regressed after NAT remains a challenge. OBJECTIVE: To evaluate marking of involved nodes by tattooing with carbon suspension, and identifying these nodes during surgery. METHODS: A small amount (0.2-0.5 ml) of carbon suspension was injected into one or two axillary LNs under ultrasound guidance at the time of LN biopsy or before or shortly after starting NAT for LN positive breast cancer. During surgery an attempt was made to identify and remove the tattooed LN as a separate specimen. All patients underwent sentinel LN mapping and biopsy and/or axillary LN dissection as mandated by their clinical status. RESULTS: Sixty three patients underwent tattooing of axillary LNs with no complications or adverse events. At surgery a tattooed node was identified in 60 patients (95%; 95% CI 87, 98). Of 56 patients who underwent sentinel mapping with Tc99, in 51 (91%; 95% CI 81, 96) at least one radioactive LN was identified. Of 50 patients in whom both radioactivity and tattoo were identified in axillary LNs, in 40 (80%; 95% CI 67, 89) LNs were radioactive and tattooed, however in 10 patients (20%; 95% CI 11, 33), the tattooed LN was not radioactive. CONCLUSIONS: Tattooing of axillary LNs is safe and easily performed. Tattooing was helpful in identifying the marked LN in the majority of cases. This technique helps to ensure that metastatic LNs are identified and removed at surgery after NAT.
Authors: Sabine R de Wild; Janine M Simons; Marie-Jeanne T F D Vrancken Peeters; Marjolein L Smidt; Linetta B Koppert Journal: Breast Care (Basel) Date: 2021-08-17 Impact factor: 2.860
Authors: Jana de Boniface; Jan Frisell; Thorsten Kühn; Ingrid Wiklander-Bråkenhielm; Karin Dembrower; Per Nyman; Athanasios Zouzos; Bernd Gerber; Toralf Reimer; Steffi Hartmann Journal: Breast Cancer Res Treat Date: 2022-04-22 Impact factor: 4.624
Authors: Maggie Banys-Paluchowski; Maria Luisa Gasparri; Jana de Boniface; Oreste Gentilini; Elmar Stickeler; Steffi Hartmann; Marc Thill; Isabel T Rubio; Rosa Di Micco; Eduard-Alexandru Bonci; Laura Niinikoski; Michalis Kontos; Guldeniz Karadeniz Cakmak; Michael Hauptmann; Florentia Peintinger; David Pinto; Zoltan Matrai; Dawid Murawa; Geeta Kadayaprath; Lukas Dostalek; Helidon Nina; Petr Krivorotko; Jean-Marc Classe; Ellen Schlichting; Matilda Appelgren; Peter Paluchowski; Christine Solbach; Jens-Uwe Blohmer; Thorsten Kühn Journal: Cancers (Basel) Date: 2021-03-29 Impact factor: 6.639