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- Title
Is There Any Advantage of Targeted Axillary Dissection after Neoadjuvant Chemotherapy in Patients with Locally Advanced Breast Cancer with Initially Positive Clipped Axillary Node?
- Authors
Cabioğlu, Neslihan; Karanlık, Hasan; Yılmaz, Ravza; Emiroğlu, Selman; Dursun, Memduh; Tükenmez, Mustafa; Yirgin, İnci Kızıldağ; Müslümanoğlu, Mahmut; İğci, Abdullah; Özmen, Vahit
- Abstract
Objective: Detection of the clipped lymph node and removal by targeted interventions with sentinel lymph node biopsy (SLNB) have been shown to reduce the false negative rates in patients with initially positive axilla following neoadjuvan chemotherapy (NAC). We aimed to evaluate the surgical advantage of targeted removal of the metastatic clipped node by various radiological methods in our clinic. Materials and Methods: Between April 2017 and September 2019, a prospective study was performed in patients with clinically node-positive locally advanced breast cancer (T1-4, N1-2). The metastatic index lymph node was marked with a clip before NAC. Sentinel lymph node biopsy (SLNB) was performed by only blue dye or combined method (radioisotope & blue dye). Based on the surgeon and radiologist preference, the clipped lymph node was marked with radioactive isotope Tc99 or wire or carbon dye on the day of surgery and presence of the clip in the lymph node was demontrated by specimen radiography. Results: Forty patients with a clipped lymph node that was radiologically visible (ultrasound or mammogram or CT) were evaluated. The median age of the patients was 45 (24-70), 3 (7.5%) of the cases before NAC were clinically (c) T1, 24 (60%) of them were cT2, 11 (27.5%) were cT3 and 2 (2) were cT4 (5%). 31 cases were N1 (77.5%) and 9 were N2 (22.5%). The clipped lymph node was removed by wire in 32 patients (80%), and by radio-guided occult lesion localisation (ROLL) in 7 patients (17.5%) and by carbon dye injection in 1 patient (2.5%). SLNB was performed with only blue dye in 27 patients (67.5%), and combined method in 13 patients (32.5%). The median number of SLN was 2 (1-5) (1 SLN in 9 patients, 2 SLNs in 17 patients, and 3= SLNs in 14 patients). The clipped lymph node was detected in 34 patients (%85) in SLNs and in 6 patients (15%) in non-SLNs with axillary dissection. The clipped lymph node pathology was found to be regression in 14 (38%), metastasis in 17 (46%), metastasis& regression in 3 (8%) and reactive changes in 3 (8%) patients. Twenty-four patients (n=24) who had positive axillary lymph node in frozen section underwent axillary lymph node dissection (91.7%) or level I axillary dissection (8.3%). The false negativity rates (FNR) evaluated in those patients with a patological positive node and ALND were 12.5% with SLNB technique alone, 12.5% by removal of the clipped lymph node alone, and 4.2% by using both techniques, respectively. Conclusion: In concordance with previous studies, our findings suggest that removal of the clipped lymph node by guidance of various radiological methods including ROLL, wire and carbon-dye injection in addition to SLNB improves the false negativity rates even more compared to each technique alone. However, experienced radiologists and surgical teams are required to perform these techniques succesfully.
- Subjects
BREAST cancer treatment; BREAST cancer surgery; SENTINEL lymph node biopsy; NEOADJUVANT chemotherapy; BREAST cancer diagnosis
- Publication
European Journal of Breast Health, 2019, Vol 15, pS25
- ISSN
2587-0831
- Publication type
Article