Targeted Axillary Dissection after Chemotherapy: Feasibility Study with Clip and Carbon Dye Tattoo – Neotarget Trial

Breast care

article

Mavioso, Carlos¹  Anacleto, João¹  Ribeiro, Joana¹  Sousa, Berta¹  Gouveia, Helena¹  Ferreira, Arlindo¹  Chumbo, Maurício¹  Vasconcelos, Maria Antónia¹  Correia, Mariana¹  Canas Marques, Rita¹  Galzerano, António¹  Brito, Maria José¹  Alves, Celeste¹  Cardoso, Fátima¹  Cardoso, Maria João¹  Pinto, David¹  Batista, Eva¹  Gouveia, Pedro¹ 

[1] Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation

关键词: Breast cancer;    Axilla;    Neoadjuvant chemotherapy;    Carbon tattoo;    Clip;   

DOI  :  10.1159/000517208

学科分类：泌尿医学

来源: S Karger AG

【 摘 要 】

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.

【 授权许可】

CC BY