Localization Of Axillary Lymph Nodes Research Articles

Radar reflector guided axillary surgery in node positive breast cancer patients

ABSTRACT Introduction In patients with non-palpable breast cancer, the availability of wireless localization techniques facilitates removal of the target lesion. One such technique uses a radar reflector for localization (RRL). This study evaluates the feasibility and effectiveness of RRL to guide excision of axillary lymph nodes in patients with node-positive breast cancer. Methods Our Breast Cancer Database was queried for patients diagnosed with breast cancer, between 5/2017 and 10/2021, who underwent preoperative placement of a radar reflector into a biopsy proven axillary lymph node. Clinicopathologic data were reported using descriptive statistics. Results Twenty patients underwent preoperative placement of a radar reflector into the axilla. Intraoperatively, the clip and radar reflector were successfully removed in all patients. Among the 10 patients treated with NAC, 5 patients achieved an axillary pathologic complete response (pCR) and were spared a complete axillary lymph node dissection (cALND). Among the entire cohort, RRL resulted in a 53% reduction in the number of lymph nodes removed. Conclusions Wireless localization of axillary lymph nodes is safe and feasible. The technique ensures excision of biopsy proven positive axillary lymph nodes and enables a targeted approach to assessing the axilla, both in the setting of NAC and upfront surgery.

Ultrasound-guided radar reflector localization of axillary lymph nodes facilitates targeted axillary dissection

PurposeThis study evaluated feasibility and patient outcomes for targeted axillary lymph node (LN) dissection (TAD) with SAVI SCOUT® ultrasound-guided radar reflector localization (RRL). MethodsIn this IRB-approved retrospective study, 800 consecutive patients who underwent ultrasound-guided RRL between November 2017 and June 2020 were reviewed. Of these patients, those with axillary LN RRL were included in this study. Reports in the electronic medical record were reviewed to determine RRL placement, retrieval, and surgical outcomes. ResultsA total of 147 patients met inclusion criteria. Of these, axillary RRL was performed for biopsy-proven metastatic disease in 134 and inconclusive or benign biopsy in 13. RRL was successful in 146/151 lymph nodes (97%). Two patients had placement >10 mm from target and 3 had no post-placement signal. In all 5, the targets were successfully retrieved at surgery. Specimen radiographs were performed in 135 cases and confirmed the intended target in all 135 (100%). In 109 patients who underwent TAD + sentinel lymph node biopsy (SLNB), the RRL LN and the SLN(s) were different in 18 (17%). In 3 of these, the RRL LN was the only malignant LN (3%). In the 105 patients who underwent neoadjuvant chemotherapy, 43% (45/105) achieved nodal pCR and 85% (89/105) had <3 metastatic lymph nodes at surgery. ConclusionUltrasound-guided RRL of axillary LNs is a feasible approach to facilitate TAD with high placement and retrieval success rates. This enables TAD as an alternative to complete axillary LN dissection (cALND), sparing some patients with low nodal tumor burden from cALND.

Pre-Operative Localization of Axillary Lymph Nodes with Tattoo Ink: A Preliminary Report

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.

Abstract P1-02-03: Our preliminary experience: Ultrasound guided localization of axillary lymph nodes using activated charcoal before neoadjuvant chemotherapy for guidance in axillary surgery in breast cancer patients

Abstract The study objective is to review the rate of identification of the biopsied lymph node during surgery by placing activated charcoal in patients with node-positive breast cancer prior to neoadjuvant chemotherapy (NAC). The secondary objective is to validate the concordance of tattooed lymph node with the sentinel nodes resected during surgery at the final pathological examination. Background: The SENTINA study concluded that for cN1 breast cancer patients that had neoadjuvant chemotherapy and afterwards had two or more sentinel node localization examined, the false negative rate (FNR) was above 10%. The ACOSOG Z1071 study showed that clipping the positive lymph node and its preoperative localization reduces the false negative rate (FNR) significantly. The use of charcoal suspension for tattooing positive nodes during the biopsy is an effective and minimal invasive technique. It avoids placing a clip and posteriorly marking it with wire or radioactive seed previous to surgery, reducing the number of procedures, costs and time. When correctly placed charcoal suspension does not affect the pathological examination. Methods: This is a retrospective pilot study form January 2016 to March 2019 that enrolled 13 cancer patients aged (26 -50 years) with clinical T1-4, N 1-2, M0 in which NAC was performed. Ultrasound axillary lymph node core biopsy and tattooing with 0,3 ml of activated charcoal suspension (Mamograf ™) in positive lymph nodes was performed prior to NAC. Patients after NAC had axillary surgery. The sentinel nodes (SN) were identified as the nodes that contained blue dye and technetium-99m. During surgery both the SN, and also the tattooed lymph nodes were removed. Evaluation of the final pathological analysis concordance between the sentinel nodes and the tattooed lymph node was performed. Results: The analysis showed that surgeons were able to successfully identify the biopsied lymph node marked with activated charcoal in 11 (84,6%) cases. The final pathology results showed concordance between the sentinel nodes and the tattooed lymph in 11 cases. There were no cases in which the tattooed lymph node did not correspond to the sentinel node. In 2 (15,4%) cases charcoal wasn´t identified neither during the surgery nor during the pathological examination. No charcoal migration to other lymph nodes was identified during surgery and in all of the cases pathological examination was not affected when the final pathology was analyzed. The final pathology results in tattooed lymph nodes was of metastases in 4 cases (36,4%), post NAC nodal fibrosis in 2 cases (18,2%) and reactive adenitis in 5 cases (45,4%). Conclusion: When visualized on ultrasound, placing activated charcoal in patients with node-positive breast cancer prior to NAC, had shown to be successful and have a high identification rate during axillary surgery. This subset analysis provides preliminary information that using charcoal suspension for tattooing positive lymph nodes before NAC has a high identification rate during axillary surgery. Larger prospective studies may probe that this new technique may change clinical approach when it comes to identifying positive lymph nodes in breast cancer patients after NAC by successfully targeting and removing them with the need of fewer radiological exams and reducing surgical times as well as overall costs. Citation Format: Africa Pineiro, Maria L Cosaka, Mora Amat, Federico Colo, Maria L Negri, Juliana Marulanda Salinas, Varela Alejandra, Loza Martin, Ponce Carolina, Victoria Constanzo, Adrian Nervo, Daniel C Mysler. Our preliminary experience: Ultrasound guided localization of axillary lymph nodes using activated charcoal before neoadjuvant chemotherapy for guidance in axillary surgery in breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-02-03.

Feasibility of Magnetic Seeds for Preoperative Localization of Axillary Lymph Nodes in Breast Cancer Treatment.

OBJECTIVE. The objective of this study was to evaluate the feasibility of using a magnetic seed system for preoperative localization of axillary lymph nodes in patients with breast cancer. MATERIALS AND METHODS. We performed a retrospective analysis that included patients with breast cancer who underwent preoperative magnetic seed localization of axillary lymph nodes at our institution between January 1, 2017, and January 1, 2019. Magseed (Endomag) is a nonradioactive inducible magnetic seed that is induced to become a magnet when under the influence of its detector in the operating room. Clinical history, prior axillary sampling and clip placement, and procedure details and surgical outcomes were determined from a search of our PACS and electronic medical records. RESULTS. Thirty-five patients (34 women and one man) composed our study cohort. The mean patient age was 56 years (range, 32-78 years). One patient underwent two separate consecutive localizations for two separate operations, and another patient had bilateral lesions, for a total of 37 axillary lymph node localizations. One case of seed misplacement occurred during the ultrasound-guided localization procedure, resulting in immediate placement of a second seed, for a total of 38 Magseeds placed. All seeds were placed under ultrasound guidance. The mean number of days from seed placement to surgery was 5 days (range, 0-31 days). Thirty-seven of 38 Magseeds (97%) were documented to be successfully retrieved in the operating room. CONCLUSION. Magseed localization appears to be a safe, nonradioactive way to accurately localize axillary lymph nodes preoperatively.

ASO Author Reflections: Ultrasound-Guided Restaging and Localization of Axillary Lymph Nodes After Neoadjuvant Chemotherapy.

ASO Author Reflections: Ultrasound-Guided Restaging and Localization of Axillary Lymph Nodes After Neoadjuvant Chemotherapy.

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.

e12615Background: The aim of this study was to review our experience with ultrasound (US)-guided localization of axillary lymph nodes using activated charcoal for the guidance of axillary surgery a...

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.

The aim of this study was to review our experience with ultrasound (US)-guided localization of axillary lymph nodes using activated charcoal for the guidance of axillary surgery after neoadjuvant chemotherapy (NAC) in clinically node-positive breast cancer patients. Between April 2016 and April 2017, US-guided localization of the most suspicious axillary lymph nodes at restaging US using activated charcoal (Charcotrace™) was performed in 45 consecutive, clinically node-positive breast cancer patients who had less than two suspicious nodes after NAC and axillary surgery with sentinel node biopsy. Sentinel nodes were defined as radioactive nodes or nodes containing blue dye. The concordance between final pathological results for both the tattooed and sentinel nodes was analyzed. Sentinel node biopsy failed in five patients (11%) in whom axillary surgery was performed under the guidance of the tattooed node. The tattooed nodes were identified in the surgical field in 44 patients (98%). Of the 44 tattooed nodes, 25 (57%) were concordant with the sentinel nodes and 19 (43%) were non-sentinel nodes, including the five nodes with failed sentinel node biopsy. In the final pathological results, 18 patients (40%) had metastatic nodes. The sensitivities for detecting axillary metastasis of the sentinel node biopsy, tattooed node biopsy, and the sentinel and/or tattooed node biopsy were 61% (11/18), 67% (12/18), and 78% (14/18), respectively. US-guided localization of axillary lymph nodes using activated charcoal at restaging after NAC in clinically node-positive breast cancer patients is a useful technique to guide axillary surgery, with a high identification rate.

CT localization of axillary lymph nodes in relation to the humeral head: Significance of arm position for radiation therapy planning

Irradiation of the axillary nodes is often indicated in the clinical radiotherapy of patients with lymphoma and breast cancer. The relative location of the axillary nodes and the humeral head has historically been estimated based on lymphangiographic data. Since CT offers more precise definition, the axillary nodal region in relation to the humeral head was systematically studied in 61 patients undergoing CT simulation for breast conservation therapy. Differences in arm position (degree of abduction) significantly affected the location of the axillary nodal region in relation to the humeral head. With the arm abducted beyond 55 degrees, humeral head blocking would result in blocking of some of the axillary nodes.