Background: Axillary staging in patients with complete response after neoadjuvant chemotherapy (NAC) is still controversial. Our objective was to test tattoo alone and subsequentially tattoo plus clip as markers in the targeted axillary dissection of ycN0 patients. Methods: Prospective cohort of cT1-T3, cN1 (proven histologically), M0 patients scheduled to receive NAC. Exclusion criteria were lobular histology, prior axillary surgery, and clinical N2/3. In cohort 1 this positive node (Neotarget node) was tattooed at diagnosis. If ycN0, a targeted axillary dissection was performed. After an interim analysis with negative results we changed the protocol in order to do a double marking procedure (Cohort 2): the positive node was clipped at diagnosis and after NAC a tattoo was done before surgery. Results: Thirteen patients in Cohort 1 and 18 patients in Cohort 2. Failure to identify the Neotarget node with multiple nodes retrieved in 9/13 (69%) of Cohort 1 patients. Also in 5/13 (38%) of Cohort 1 patients and 3/18 (17%) of Cohort 2 there was a failure to clearly identify tattooed nodes. In Cohort 2, clip identification by surgical specimen radiography allowed the identification of the tagged node in 17/18 (94,4%) of cases. The concordance between the clipped node and sentinel nodes was 16/18 (89%). Conclusions: The introduction of double marking by clipping the metastatic node and verifying their removal by surgical specimen radiography, using carbon ink as a tracer, allowed the identification of the metastatic node in 94% of cases, with a simple, reproducible, and easy-to-implement targeted axillary dissection procedure.
Background: Axillary staging in patients with complete response after neoadjuvant chemotherapy (NAC) is still controversial. Our objective was to test tattoo alone and subsequentially tattoo plus clip as markers in the targeted axillary dissection of ycN0 patients. Methods: Prospective cohort of cT1-T3, cN1 (proven histologically), M0 patients scheduled to receive NAC. Exclusion criteria were lobular histology, prior axillary surgery, and clinical N2/3. In cohort 1 this positive node (Neotarget node) was tattooed at diagnosis. If ycN0, a targeted axillary dissection was performed. After an interim analysis with negative results we changed the protocol in order to do a double marking procedure (Cohort 2): the positive node was clipped at diagnosis and after NAC a tattoo was done before surgery. Results: Thirteen patients in Cohort 1 and 18 patients in Cohort 2. Failure to identify the Neotarget node with multiple nodes retrieved in 9/13 (69%) of Cohort 1 patients. Also in 5/13 (38%) of Cohort 1 patients and 3/18 (17%) of Cohort 2 there was a failure to clearly identify tattooed nodes. In Cohort 2, clip identification by surgical specimen radiography allowed the identification of the tagged node in 17/18 (94,4%) of cases. The concordance between the clipped node and sentinel nodes was 16/18 (89%). Conclusions: The introduction of double marking by clipping the metastatic node and verifying their removal by surgical specimen radiography, using carbon ink as a tracer, allowed the identification of the metastatic node in 94% of cases, with a simple, reproducible, and easy-to-implement targeted axillary dissection procedure.
Authors: J A van der Hage; C J van de Velde; J P Julien; M Tubiana-Hulin; C Vandervelden; L Duchateau Journal: J Clin Oncol Date: 2001-11-15 Impact factor: 44.544
Authors: H J Burstein; G Curigliano; S Loibl; P Dubsky; M Gnant; P Poortmans; M Colleoni; C Denkert; M Piccart-Gebhart; M Regan; H-J Senn; E P Winer; B Thurlimann Journal: Ann Oncol Date: 2019-10-01 Impact factor: 32.976
Authors: David N Krag; Stewart J Anderson; Thomas B Julian; Ann M Brown; Seth P Harlow; Takamaru Ashikaga; Donald L Weaver; Barbara J Miller; Lynne M Jalovec; Thomas G Frazier; R Dirk Noyes; André Robidoux; Hugh M C Scarth; Denise M Mammolito; David R McCready; Eleftherios P Mamounas; Joseph P Costantino; Norman Wolmark Journal: Lancet Oncol Date: 2007-10 Impact factor: 41.316
Authors: Amit Goyal; Shama Puri; Andrea Marshall; Kalliope Valassiadou; Moin M Hoosein; Amtul R Carmichael; Gabriella Erdelyi; Nisha Sharma; Janet Dunn; Joanne York Journal: Breast Cancer Res Treat Date: 2020-10-06 Impact factor: 4.872
Authors: Abigail S Caudle; Wei T Yang; Savitri Krishnamurthy; Elizabeth A Mittendorf; Dalliah M Black; Michael Z Gilcrease; Isabelle Bedrosian; Brian P Hobbs; Sarah M DeSnyder; Rosa F Hwang; Beatriz E Adrada; Simona F Shaitelman; Mariana Chavez-MacGregor; Benjamin D Smith; Rosalind P Candelaria; Gildy V Babiera; Basak E Dogan; Lumarie Santiago; Kelly K Hunt; Henry M Kuerer Journal: J Clin Oncol Date: 2016-01-25 Impact factor: 44.544
Authors: Umberto Veronesi; Giovanni Paganelli; Giuseppe Viale; Alberto Luini; Stefano Zurrida; Viviana Galimberti; Mattia Intra; Paolo Veronesi; Chris Robertson; Patrick Maisonneuve; Giuseppe Renne; Concetta De Cicco; Francesca De Lucia; Roberto Gennari Journal: N Engl J Med Date: 2003-08-07 Impact factor: 91.245
Authors: Won Hwa Kim; Hye Jung Kim; See Hyung Kim; Jin Hyang Jung; Ho Yong Park; Jeeyeon Lee; Wan Wook Kim; Ji Young Park; Yee Soo Chae; Soo Jung Lee Journal: BMC Cancer Date: 2019-08-30 Impact factor: 4.430
Authors: C S Pinto; B Peleteiro; C A Pinto; F Osório; S Costa; A Magalhães; H Mora; J Amaral; D Gonçalves; J L Fougo Journal: Breast Cancer Date: 2022-03-19 Impact factor: 3.307