SPECT/CT Lymphoscintigraphy Guidance Simplifies and Improves Targeted Axillary Dissection of the Clipped Nodes After Neoadjuvant Chemotherapy in Initially Node-Positive Breast Cancer.
Axilla
/ pathology
Breast Neoplasms
/ diagnostic imaging
Female
Humans
Lymph Node Excision
/ methods
Lymph Nodes
/ diagnostic imaging
Lymphoscintigraphy
Neoadjuvant Therapy
/ methods
Neoplasm Staging
Sentinel Lymph Node Biopsy
/ methods
Single Photon Emission Computed Tomography Computed Tomography
Surgical Instruments
Journal
Clinical nuclear medicine
ISSN: 1536-0229
Titre abrégé: Clin Nucl Med
Pays: United States
ID NLM: 7611109
Informations de publication
Date de publication:
01 11 2022
01 11 2022
Historique:
pubmed:
15
7
2022
medline:
13
10
2022
entrez:
14
7
2022
Statut:
ppublish
Résumé
We assessed the feasibility of SPECT/CT lymphoscintigraphy ( 99m Tc-nanocolloid) method to simplify and improve targeted axillary dissection of clipped axillary lymph node (axLN) after neoadjuvant chemotherapy (NAC) in initially node-positive breast cancer. Fifteen patients who had clip placement to biopsy-confirmed axLN metastasis due to clinically node-positive breast cancer before NAC and underwent SPECT/CT lymphoscintigraphy for surgery after NAC were included into the study. SPECT/CT lymphoscintigraphy was performed to localize the clipped node and to assess if the clipped lymph node (LN) had 99m Tc-nanocolloid uptake or not. In case the clipped node had no uptake on SPECT/CT, the patient was referred to wire-guided localization procedure. Blue dye was also injected for dual mapping of sentinel LN biopsy. All patients had only ipsilateral axLN metastasis. SPECT/CT lymphoscintigraphy showed that clipped LNs were radioavid in 12 of 15 patients (80%). Clipped LNs were not blue-stained in 5 patients (33.3%), and in 2 of them, clipped LNs were radioavid in SPECT/CT. Wire-guided localization was required in only 3 patients (20%) for nonradioavid/blue-stained clipped LNs. Removal of the clipped nodes was confirmed in all cases with a success rate of 100% by specimen graphy. SPECT/CT lymphoscintigraphy seems feasible to determine the clipped LNs intraoperatively without requiring additional invasive methods in most of the patients. This technique simplifies and improves targeted axillary dissection of the clipped axLNs after NAC in initially node-positive breast cancer and can be adapted to clinical practice with further investigations.
Identifiants
pubmed: 35835147
doi: 10.1097/RLU.0000000000004340
pii: 00003072-202211000-00027
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e682-e688Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest and sources of funding: none declared.
Références
Maguire A, Brogi E. Sentinel lymph nodes for breast carcinoma: an update on current practice. Histopathology . 2016;68:152–167.
Cao S, Liu X, Cui J, et al. Feasibility and reliability of sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients with positive axillary nodes at initial diagnosis: an up-to-date meta-analysis of 3,578 patients. Breast . 2021;59:256–269.
Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA . 2013;310:1455–1461.
Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol . 2013;14:609–618.
Boileau J-F, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol . 2015;33:258–264.
Caudle AS, Yang WT, Krishnamurthy S, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol . 2016;34:1072–1078.
Straver ME, Loo CE, Alderliesten T, et al. Marking the axilla with radioactive iodine seeds (MARI procedure) may reduce the need for axillary dissection after neoadjuvant chemotherapy for breast cancer. Br J Surg . 2010;97:1226–1231.
Alderliesten T, Loo CE, Pengel KE, et al. Radioactive seed localization of breast lesions: an adequate localization method without seed migration. Breast J . 2011;17:594–601.
Balasubramanian R, Morgan C, Shaari E, et al. Wire guided localisation for targeted axillary node dissection is accurate in axillary staging in node positive breast cancer following neoadjuvant chemotherapy. Eur J Surg Oncol . 2020;46:1028–1033.
Kim EY, Byon WS, Lee KH, et al. Feasibility of preoperative axillary lymph node marking with a clip in breast cancer patients before neoadjuvant chemotherapy: a preliminary study. World J Surg . 2018;42:582–589.
Donker M, Drukker CA, Valdés Olmos RA, et al. Guiding breast-conserving surgery in patients after neoadjuvant systemic therapy for breast cancer: a comparison of radioactive seed localization with the ROLL technique. Ann Surg Oncol . 2013;20:2569–2575.
Amin MB, Edge S, Byrd D. AJCC Cancer Staging Manual . 8th ed. France: Springer International Publishing; 2017.
International Commission on Radiological Protection. The 2007 recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP . 2007;37:1–332.
Murgo S, Wyshoff H, Faverly D, et al. Computed tomography–guided localization of breast lesions. Breast J . 2008;14:169–175.
Trinh L, Miyake KK, Dirbas FM, et al. CT-guided wire localization for involved axillary lymph nodes after neo-adjuvant chemotherapy in patients with initially node-positive breast cancer. Breast J . 2016;22:390–396.
Pilewskie M, Morrow M. Axillary nodal management following neoadjuvant chemotherapy: a review. JAMA Oncol . 2017;3:549–555.
Rajan R, Esteva FJ, Symmans WF. Pathologic changes in breast cancer following neoadjuvant chemotherapy: implications for the assessment of response. Clin Breast Cancer . 2004;5:235–238.
Man V, Kwong A. Different strategies in marking axillary lymph nodes in breast cancer patients undergoing neoadjuvant medical treatment: a systematic review. Breast Cancer Res Treat . 2021;186:607–615.
Cabioğlu N, Karanlik H, Kangal D, et al. Improved false-negative rates with intraoperative identification of clipped nodes in patients undergoing sentinel lymph node biopsy after neoadjuvant chemotherapy. Ann Surg Oncol . 2018;25:3030–3036.
Hellingman D, Donswijk ML, Winter-Warnars GAO, et al. Feasibility of radioguided occult lesion localization of clip-marked lymph nodes for tailored axillary treatment in breast cancer patients treated with neoadjuvant systemic therapy. EJNMMI Res . 2019;9:94.
Smith-Bindman R, Wang Y, Chu P, et al. International variation in radiation dose for computed tomography examinations: prospective cohort study. BMJ . 2019;364:k4931.