Tara M Balija1, Devin Braz2, Sara Hyman2, Leslie L Montgomery2. 1. Department of Surgery, Division of Breast Surgery, Hackensack Meridian School of Medicine, 20 Prospect Avenue, Suite 402, Hackensack, NJ, 07601, USA. tara.balija@hmhn.org. 2. Department of Surgery, Division of Breast Surgery, Hackensack Meridian School of Medicine, 20 Prospect Avenue, Suite 402, Hackensack, NJ, 07601, USA.
Abstract
PURPOSE: Clipped axillary lymph node (CALN) localization after neoadjuvant chemotherapy (NAC) for axillary node positive breast cancer can be difficult due to significant shrinkage or disappearance of the CALN after NAC. This study compares wire localization to a radar-based localization system utilizing a reflector that can be placed before or during NAC, in the months before definitive surgery, to facilitate accurate localization and excision of the CALN. METHODS: Between 2016 and 2019, women with T0-4 N1-3 M0 breast cancer who underwent NAC followed by axillary surgery with planned excision of a biopsy positive or clinically suspicious axillary node via wire or reflector localization were identified. A retrospective chart review was performed comparing successful localization and CALN retrieval by each localization technique. RESULTS: Ninety-nine patients met inclusion criteria. Forty-two patients underwent wire localization while 57 patients underwent reflector localization of the CALN. Successful identification of the CALN by wire or reflector was equivalent (83.3% vs 84.2%, respectively). Twenty-two reflectors placed before or during early/mid NAC (early placement) had 100% successful CALN localization and retrieval in the OR. Placement of wire or reflector localization devices within 8 weeks of surgery (late placement) only resulted in 79.2% localization success (p = .02). CONCLUSION: This study suggests a benefit of axillary lymph node reflector placement in the early NAC setting. Early reflector placement allows for more accurate excision of the CALN during axillary surgery after NAC as compared to placement of localization wires or reflectors in the few weeks prior to surgery.
PURPOSE: Clipped axillary lymph node (CALN) localization after neoadjuvant chemotherapy (NAC) for axillary node positive breast cancer can be difficult due to significant shrinkage or disappearance of the CALN after NAC. This study compares wire localization to a radar-based localization system utilizing a reflector that can be placed before or during NAC, in the months before definitive surgery, to facilitate accurate localization and excision of the CALN. METHODS: Between 2016 and 2019, women with T0-4 N1-3 M0 breast cancer who underwent NAC followed by axillary surgery with planned excision of a biopsy positive or clinically suspicious axillary node via wire or reflector localization were identified. A retrospective chart review was performed comparing successful localization and CALN retrieval by each localization technique. RESULTS: Ninety-nine patients met inclusion criteria. Forty-two patients underwent wire localization while 57 patients underwent reflector localization of the CALN. Successful identification of the CALN by wire or reflector was equivalent (83.3% vs 84.2%, respectively). Twenty-two reflectors placed before or during early/mid NAC (early placement) had 100% successful CALN localization and retrieval in the OR. Placement of wire or reflector localization devices within 8 weeks of surgery (late placement) only resulted in 79.2% localization success (p = .02). CONCLUSION: This study suggests a benefit of axillary lymph node reflector placement in the early NAC setting. Early reflector placement allows for more accurate excision of the CALN during axillary surgery after NAC as compared to placement of localization wires or reflectors in the few weeks prior to surgery.
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Authors: Judy C Boughey; Vera J Suman; Elizabeth A Mittendorf; Gretchen M Ahrendt; Lee G Wilke; Bret Taback; A Marilyn Leitch; Henry M Kuerer; Monet Bowling; Teresa S Flippo-Morton; David R Byrd; David W Ollila; Thomas B Julian; Sarah A McLaughlin; Linda McCall; W Fraser Symmans; Huong T Le-Petross; Bruce G Haffty; Thomas A Buchholz; Heidi Nelson; Kelly K Hunt Journal: JAMA Date: 2013-10-09 Impact factor: 56.272
Authors: Judy C Boughey; Karla V Ballman; Huong T Le-Petross; Linda M McCall; Elizabeth A Mittendorf; Gretchen M Ahrendt; Lee G Wilke; Bret Taback; Eric C Feliberti; Kelly K Hunt Journal: Ann Surg Date: 2016-04 Impact factor: 12.969