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Cui Y, Xia H, Liu Q, Ma B, Pan M, Shang C, Zhang Q, Wang Y, Chen B, Guo H. A Tumor-Activatable Liposomal Nanoprobe for Selective Visualization of Metastatic Lymph Nodes. Adv Healthc Mater 2024:e2401935. [PMID: 39104023 DOI: 10.1002/adhm.202401935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/23/2024] [Indexed: 08/07/2024]
Abstract
The precise identification of sentinel lymph nodes (SLNs) during surgery and assessment of their benign status is crucial for accurate tumor staging and optimal treatment strategizing. Currently, a deficiency exists in non-invasive in vivo diagnostic techniques that can accurately pinpoint SLNs during surgery while simultaneously evaluating their benign status. Here, a tumor-activatable liposomal nanoprobe (nTAL) is developed, remotely loaded with clinically approved photosensitizer, methyl aminolevulinate (MAL), to noninvasively visualize the tumor metastasis lymph nodes (LNs) with precision. Benefited from the highly efficient LNs draining of nanosized liposome and tumor cell-specific transformation of the non-fluorescent MAL to fluorescent protoporphyrin IX (PPIX), nTAL succeeded in targeting the SLNs and differentiated the metastatic from the benign ones with a positive correlation between PPIX generation and tumor cell infiltration in LNs. Moreover, the nTAL technology is capable of probing the early metastatic stage with a primary tumor size of 50 mm3. This study provides a new strategy for intraoperative visualization of real-time sentinel node dissection.
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Affiliation(s)
- Yi Cui
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Heming Xia
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Qiyu Liu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Bin Ma
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Meijie Pan
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Chunliang Shang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Qiang Zhang
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Yiguang Wang
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Binlong Chen
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Hongyan Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
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Cabıoğlu N, Karanlık H, Yılmaz R, Emiroğlu S, Tükenmez M, Bademler S, Şimşek DH, Kantarcı TR, Yirgin İK, Bayram A, Dursun M. Targeted axillary dissection reduces residual nodal disease in clinically node- positive breast cancer after neoadjuvant chemotherapy. World J Surg Oncol 2024; 22:178. [PMID: 38971793 PMCID: PMC11227135 DOI: 10.1186/s12957-024-03413-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/14/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Any advantage of performing targeted axillary dissection (TAD) compared to sentinel lymph node (SLN) biopsy (SLNB) is under debate in clinically node-positive (cN+) patients diagnosed with breast cancer. Our objective was to assess the feasibility of the removal of the clipped node (RCN) with TAD or without imaging-guided localisation by SLNB to reduce the residual axillary disease in completion axillary lymph node dissection (cALND) in cN+ breast cancer. METHODS A combined analysis of two prospective cohorts, including 253 patients who underwent SLNB with/without TAD and with/without ALND following NAC, was performed. Finally, 222 patients (cT1-3N1/ycN0M0) with a clipped lymph node that was radiologically visible were analyzed. RESULTS Overall, the clipped node was successfully identified in 246 patients (97.2%) by imaging. Of 222 patients, the clipped lymph nodes were non-SLNs in 44 patients (19.8%). Of patients in cohort B (n=129) with TAD, the clipped node was successfully removed by preoperative image-guided localisation, or the clipped lymph node was removed as the SLN as detected on preoperative SPECT-CT. Among patients with ypSLN(+) (n=109), no significant difference was found in non-SLN positivity at cALND between patients with TAD and RCN (41.7% vs. 46.9%, p=0.581). In the subgroup with TAD with axillary lymph node dissection (ALND; n=60), however, patients with a lymph node (LN) ratio (LNR) less than 50% and one metastatic LN in the TAD specimen were found to have significantly decreased non-SLN positivity compared to others (27.6% vs. 54.8%, p=0.032, and 22.2% vs. 50%, p=0.046). CONCLUSIONS TAD by imaging-guided localisation is feasible with excellent identification rates of the clipped node. This approach has also been found to reduce the additional non-SLN positivity rate to encourage omitting ALND in patients with a low metastatic burden undergoing TAD.
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Affiliation(s)
- Neslihan Cabıoğlu
- Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye.
| | - Hasan Karanlık
- Department of Surgical Oncology, Istanbul University, Institute of Oncology, Istanbul, Türkiye
| | - Ravza Yılmaz
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Selman Emiroğlu
- Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Mustafa Tükenmez
- Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Süleyman Bademler
- Department of Surgical Oncology, Istanbul University, Institute of Oncology, Istanbul, Türkiye
| | - Duygu Has Şimşek
- Department of Nuclear Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Tarık Recep Kantarcı
- Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - İnci Kızıldağ Yirgin
- Department of Radiology, Istanbul University, Institute of Oncology, Istanbul, Türkiye
| | - Aysel Bayram
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Memduh Dursun
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
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Gante I, Maldonado JP, Figueiredo Dias M. Marking Techniques for Targeted Axillary Dissection Among Patients With Node-Positive Breast Cancer Treated With Neoadjuvant Chemotherapy. Breast Cancer (Auckl) 2023; 17:11782234231176159. [PMID: 37255883 PMCID: PMC10226338 DOI: 10.1177/11782234231176159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/28/2023] [Indexed: 06/01/2023] Open
Abstract
Invasive breast cancer with axillary lymph node (LN) invasion is a continuing problem worldwide. The morbidity associated with axillary LN dissection along with the high rate of nodal downstaging after neoadjuvant chemotherapy (NACT) made the standard treatment shift towards less invasive surgery. Sentinel lymph node biopsy (SLNB) after NACT is associated with high false-negative rates (13%-14%). To overcome this problem, it was concluded that the positive nodes should first be indicated with image-detectable markers and then removed together with SLNB: targeted axillary dissection (TAD). This review aims to describe and evaluate the different marking techniques for TAD in patients with node-positive breast cancer treated with NACT, namely: clip placement and guidewire localization; clip placement and 125I-labelled radioactive seed localization; clip placement and skin mark; clip placement and intraoperative ultrasound; tattooing with a sterile black carbon suspension; magnetic seeds; radar and infrared light technology localization. Targeted axillary dissection techniques have shown false-negative rates below 9% and identification rates above 95%. The most studied technique is guidewire localization, as it is also the oldest one. However, according to data gathered from this review, some newer techniques have shown to be very promising due to their statistical results and management factors.
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Affiliation(s)
- Inês Gante
- Department of Gynecology, Coimbra
Hospital and Universitary Centre, Coimbra, Portugal
- Gynecologic University Clinic, Faculty
of Medicine, University of Coimbra, Coimbra, Portugal
- Area of Environment, Genetics and
Oncobiology (CIMAGO), Coimbra Institute for Clinical and Biomedical Research (iCBR),
Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Pedro Maldonado
- Gynecologic University Clinic, Faculty
of Medicine, University of Coimbra, Coimbra, Portugal
| | - Margarida Figueiredo Dias
- Department of Gynecology, Coimbra
Hospital and Universitary Centre, Coimbra, Portugal
- Gynecologic University Clinic, Faculty
of Medicine, University of Coimbra, Coimbra, Portugal
- Area of Environment, Genetics and
Oncobiology (CIMAGO), Coimbra Institute for Clinical and Biomedical Research (iCBR),
Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Yang QH, Zhang XJ. Indocyanine green combined with methylene blue versus methylene blue alone for sentinel lymph node biopsy in breast cancer: a retrospective study. BMC Surg 2023; 23:133. [PMID: 37198675 DOI: 10.1186/s12893-023-02037-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Recent studies have shown that near-infrared (NIR) fluorescence imaging using Indocyanine green (ICG) may improve the efficiency of sentinel lymph node biopsy (SLNB). This study aimed to assess the effectiveness of the combination of ICG and methylene blue (MB) in breast cancer patients undergoing SLNB. PATIENTS AND METHOD We evaluated ICG plus MB (ICG + MB) identification effectiveness with MB alone using retrospective analysis. From 2016 to 2020, we collected data on 300 eligible breast cancer patients who got SLNB treatment in our institution by ICG + MB or MB alone. By comparing the distribution of clinicopathological characteristics, the detection rate of sentinel lymph nodes (SLNs) and metastatic SLNs, as well as the total number of SLNs in the two groups, we were able to assess the imaging efficiency. RESULTS Fluorescence imaging allowed 131 out of 136 patients in the ICG + MB group to find SLNs. ICG + MB group and MB group had detection rates of 98.5% and 91.5% (P = 0.007, χ2 = 7.352), respectively. Besides, the ICG + MB approach was able to produce improved recognition outcomes. What's more, compared with the MB group, the ICG + MB group can identify more lymph nodes (LNs) (3.1 to 2.6, P = 0.000, t = 4.447). Additionally, in the ICG + MB group, ICG could identify more LNs than MB (3.1 vs 2.6, P = 0.004, t = 2.884). CONCLUSION ICG has high detection effectiveness for SLNs, and when paired with MB, the detection efficiency can be increased even further. Furthermore, the ICG + MB tracing mode does not involve radioisotopes, which has a lot of promise for clinical use and can take the place of conventional standard detection methods.
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Affiliation(s)
- Qiu-Hui Yang
- Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Xiang-Jian Zhang
- The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
- Department of Surgical Oncology, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China.
- The Second Affiliated Hospital of Shanghai University, Wenzhou, Zhejiang, 325000, China.
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Pan HY, Zhang Q, Wu WJ, Li X. Preoperative neoadjuvant chemotherapy in patients with breast cancer evaluated using strain ultrasonic elastography. World J Clin Cases 2022; 10:7293-7301. [PMID: 36158032 PMCID: PMC9353890 DOI: 10.12998/wjcc.v10.i21.7293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/25/2022] [Accepted: 06/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of breast cancer in China is increasing while its mortality rate is decreasing. The annual breast cancer incidence in China is 39.2 million, accounting for two-thirds of the urban population. In China, breast cancer is the fifth most common malignant tumor overall and the most common in women, accounting for 17% of female malignant tumors.
AIM To investigate the accuracy of strain ultrasound elastography (SUE) on the evaluation of preoperative neoadjuvant chemotherapy (NAC) in breast cancer.
METHODS Overall, 90 patients with breast cancer treated at our hospital between January 2018 and February 2019 were selected for this study. The patients received six cycles of NAC with docetaxel, epirubicin, and cyclophosphamide. Surgical treatment was also performed, and pathological reactivity was assessed. The patients were evaluated using conventional ultrasonography and SUE before biopsy. The differences between groups were analyzed to calculate the mean and standard deviation with significance measured using a t-test, while multivariate analysis was performed using logistic regression analysis.
RESULTS Of the patients analyzed, 20 had a pathological complete remission (pCR) while 70 did not achieve pCR after NAC. The ratio of the elastic strain ratio (SR) and elastic score of 4–5 in patients with pCR were 5.5 ± 1.16 and 15.00%, respectively; these were significantly lower than those in patients without pCR (85%) and significantly higher than in patients without pCR (14%). SR and elastic score 4–5 were independent factors influencing NAC efficacy (OR=0.644, 1.426 and 1.366, respectively, P < 0.05). SR was positively correlated with elasticity score (rs = 0.411, P < 0.05). The area under the receiver operator characteristic curve of SR and SR combined with elastic score in predicting patients without pCR was 0.822 and 0.891, respectively (P < 0.05).
CONCLUSION Strain ultrasonic elastography may be used to evaluate the effects of preoperative NAC in patients with breast cancer.
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Affiliation(s)
- Hong-Yu Pan
- Department of Ultrasound, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Qian Zhang
- Department of Ultrasound, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Wen-Jing Wu
- Department of Ultrasound, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Xia Li
- Department of Ultrasound, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
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Pinto CS, Peleteiro B, Pinto CA, Osório F, Costa S, Magalhães A, Mora H, Amaral J, Gonçalves D, Fougo JL. Initial experience with targeted axillary dissection after neoadjuvant therapy in breast cancer patients. Breast Cancer 2022; 29:709-719. [PMID: 35304711 PMCID: PMC8933233 DOI: 10.1007/s12282-022-01349-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/09/2022] [Indexed: 02/06/2023]
Abstract
Background Targeted axillary dissection (TAD) combines sentinel node biopsy (SNB) with the removal of the previously marked metastatic node. TAD is a promising concept for axillary restaging in node-positive breast cancer patients with pathological complete response (pCR) to neoadjuvant therapy (NAT). We aimed to evaluate TAD feasibility in this context. Methods A prospective observational study was conducted in biopsy-confirmed cN1 patients. The removal of the clipped node (CN) was guided by intraoperative ultrasound. SNB used indocyanine green and patent blue V dye. If the CN or sentinel lymph nodes (SLN) had any metastatic foci, or the TAD procedure was unsuccessful, the patient underwent axillary lymph node dissection (ALND). Results Thirty-seven patients were included. TAD and SNB identification rates were 97.3%. Every retrieved CN was also a SLN. At the individual level, SNB identification rate was 89.2% with indocyanine green and 85.5% with patent blue V dye. The CN identification rate was 81.1%, being higher when the CN was localized on the intraoperative ultrasound (84.4% vs 60.0%). Nodal pCR was achieved by 54.1% of our patients and was more frequent in HER2-positive and triple-negative tumors (p = 0.039). Nineteen patients were spared from ALND. Conclusion TAD with intraoperative ultrasound-guided excision of the CN and SNB with indocyanine green and patent blue V dye is a feasible concept to identify patients without axillary residual disease after NAT, that can be spared from ALND, although the need for marking the biopsied node should be further investigated.
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Affiliation(s)
- C S Pinto
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - B Peleteiro
- EPIUnit-Institute of Public Health, University of Porto, Rua das Taipas, 135, 4050-598, Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas, 135, 4050-598, Porto, Portugal
| | - C A Pinto
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - F Osório
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Centro de Mama, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - S Costa
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Centro de Mama, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - A Magalhães
- Centro de Mama, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - H Mora
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Centro de Mama, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - J Amaral
- Centro de Mama, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - D Gonçalves
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Centro de Mama, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - J L Fougo
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Centro de Mama, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Rebollo Aguirre A, Fernández Fernández J, Sánchez Sánchez R, Mendoza Arnau I, Rivas Navas D, Martínez Meca S. Radioguided surgery with iodine-125 seeds in breast cancer patients treated with neoadjuvant chemotherapy. Rev Esp Med Nucl Imagen Mol 2022; 41:71-77. [DOI: 10.1016/j.remnie.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
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Yang J, He T, Wu Y, Fu Z, Lv Q, Lu S, Wang X, Li H, Wang J, Chen J. Nanoparticle-assisted axillary staging: an alternative approach after neoadjuvant chemotherapy in patients with pretreatment node-positive breast cancers. Breast Cancer Res Treat 2022; 192:573-582. [PMID: 35129717 DOI: 10.1007/s10549-022-06539-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/29/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE In order to achieve an optimized method of axillary staging after neoadjuvant chemotherapy (NAC) in breast cancer patients with pretreatment positive axillary lymph nodes, we evaluated the feasibility and accuracy of nanoparticle-assisted axillary staging (NAAS) which combines carbon nanoparticles with standard sentinel lymph node biopsy (SLNB) with radioisotope and blue dye. METHODS Invasive breast cancer patients with pre-NAC positive axillary lymph nodes who converted to ycN0 and received surgeries from November 2020 to March 2021 were included. All patients underwent ipsilateral NAAS followed by axillary lymph node dissection. Detection rate (DR), false-negative rate (FNR), negative predictive value (NPV) and accuracy of axillary staging were calculated. RESULTS Eighty of 136 (58.8%) breast cancer patients converted to ycN0 after NAC and received NAAS. The DR, NPV and accuracy was 95.0%, 93.3% and 97.4% for NAAS, respectively. And the FNR was 4.2% (2/48) for NAAS, which was lower than that of standard dual-tracer SLNB (SD-SLNB) (9.5%, 4/42). Pretreatment clinical T4 classification was a risk factor for detection failure in NAAS (p = 0.016). When patients with pretreatment inflammatory breast cancers were excluded from analysis, FNR dropped to 2.2% (1/45) for NAAS. CONCLUSION NAAS revealed great performance in invasive breast cancer patients with pre-NAC positive axillary lymph nodes who converted to ycN0. The application of NAAS reached a better balance between more accurate axillary evaluation and less intervention. Trial registration Chictr.org.cn (ChiCTR2000039814). Registered Nov 11, 2020.
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Affiliation(s)
- Jiqiao Yang
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China.,Clinical Research Center for Breast Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Tao He
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Yunhao Wu
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Zhoukai Fu
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Qing Lv
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Shan Lu
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Xiaodong Wang
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Hongjiang Li
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Jing Wang
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Jie Chen
- Department of Breast Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China.
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Lv ZD, Song HM, Niu ZH, Nie G, Zheng S, Xu YY, Gong W, Wang HB. Efficacy and Safety of Albumin-Bound Paclitaxel Compared to Docetaxel as Neoadjuvant Chemotherapy for HER2-Negative Breast Cancer. Front Oncol 2022; 11:760655. [PMID: 35087749 PMCID: PMC8787090 DOI: 10.3389/fonc.2021.760655] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/13/2021] [Indexed: 01/15/2023] Open
Abstract
Background Nanoparticle albumin-bound paclitaxel (nab-paclitaxel) as neoadjuvant chemotherapy (NAC) for breast cancer remains controversial. We conducted a retrospective study to compare the efficacy and safety of nab-paclitaxel with those of docetaxel as neoadjuvant regimens for HER2-negative breast cancer. Methods In this retrospective analysis, a total of 159 HER2-negative breast cancer patients who had undergone operation after NAC were consecutively analyzed from May 2016 to April 2018. Patients were classified into the nab-paclitaxel group (n = 79, nab-paclitaxel 260 mg/m2, epirubicin 75 mg/m2, and cyclophosphamide 500 mg/m2) and the docetaxel group (n = 80, docetaxel 75 mg/m2, epirubicin 75 mg/m2, and cyclophosphamide 500 mg/m2) according to the drug they received for neoadjuvant treatment. The efficacy and adverse events were evaluated in the two groups. Results The pathological complete response (pCR)(ypT0/isN0) rate was significantly higher in the nab-paclitaxel group than in the docetaxel group (36.71% vs 20.00%; P = 0.031). The multivariate analysis revealed that therapeutic drugs, lymph node status, and tumor subtype were the most significant factor influencing treatment outcome. At a median follow-up of 47 months, disease-free survival (DFS) was not significantly different in those assigned to nab-paclitaxel compared with docetaxel (82.28% vs 76.25%; P = 0.331). The incidence of peripheral sensory neuropathy in the nab-paclitaxel group was higher than that in the docetaxel group (60.76% vs 36.25%; P = 0.008), while the incidence of arthralgia was observed more frequently in the docetaxel group (57.50% vs 39.97%; P = 0.047). Conclusions Compared with docetaxel, nab-paclitaxel achieved a higher pCR rate, especially those patients with triple-negative breast cancer or lymph node negative breast cancer. However, there was no significant difference in DFS between the two groups. This study provides a valuable reference for the management of patients with HER2-negative breast cancer.
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Affiliation(s)
- Zhi-Dong Lv
- Breast Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hong-Ming Song
- Breast Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhao-He Niu
- Breast Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Gang Nie
- Breast Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuai Zheng
- Department of Breast and Thyroid Surgery, Heze Municipal Hospital, Heze, China
| | - Ying-Ying Xu
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Gong
- Department of Thyroid and Breast Surgery, The Second People's Hospital of Kunshan, Kunshan, China
| | - Hai-Bo Wang
- Breast Center, The Affiliated Hospital of Qingdao University, Qingdao, China
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Rebollo Aguirre AC, Fernández Fernández J, Sánchez Sánchez R, Mendoza Arnau I, Rivas Navas DJ, Martínez Meca S. Radioguided surgery with iodine-125 seeds in breast cancer patients treated with neoadjuvant chemotherapy. Rev Esp Med Nucl Imagen Mol 2021; 41:S2253-654X(21)00067-6. [PMID: 33863696 DOI: 10.1016/j.remn.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the use of radioactive iodine-125 seed (RIS) in breast and/or axillary surgery, in patients with breast cancer treated with neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS Prospective study between January 2016 and June 2020. 80 women T1-3,N0-2,M0: 30 RIS marking the breast tumor, 36 both the tumor and the biopsied positive axillary node, and 14 only the axilla. Age: 54.7±11.4 years. Tumor size: 34.1±14.6mm. Histological type: invasive ductal carcinoma 90.0%. Molecular subtypes: luminal-A 23.8%, luminal-B/HER2- 33.7%, luminal-B/HER2+ 18.8%, HER2+ 7.5%, basal-like 16,2%. RESULTS Of the 66 patients with RIS marking of the tumor (51 pre-NAC, 15 post-NAC), 92.1% had tumor-free surgical margins, with a specimen volume of 126.7±111.2 cm3. Of the 5 second local excisions, in 3 the resection margin was involved (1 mastectomy). Of the 50 patients N1 with RIS marking (MLN), 44 pre-NAC and 6 post-NAC, MLN was identified in 97.2%: negative 23, positive 26. In 45/50 patients, sentinel node biopsy (SNB) was performed and it was identified in 93.3%: negative 26, positive 16. In 1 case RIS was not placed correctly and SNB was not identified due to non-migration. In 61.9% of the patients, MLN was among the SNB identified in the surgery. In 5 patients with mismatched SNB and MLN, the pathological result of the SNB was negative and the MLN was positive. Axillary lymph node dissection was performed in 53.8% of the patients. CONCLUSION RIS allow to perform breast-conserving surgery and improve detection of residual axillary disease in patients treated with NAC.
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Affiliation(s)
- A C Rebollo Aguirre
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - J Fernández Fernández
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - R Sánchez Sánchez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - I Mendoza Arnau
- Servicio de Radiodiagnóstico. Hospital Universitario Virgen de las Nieves, Granada, España
| | - D J Rivas Navas
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España
| | - S Martínez Meca
- Servicio de Radiodiagnóstico. Hospital Universitario Virgen de las Nieves, Granada, España
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11
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Effects of iron oxide particles on MRI and mammography in breast cancer patients after a sentinel lymph node biopsy with paramagnetic tracers. Clin Imaging 2020; 75:22-26. [PMID: 33486148 DOI: 10.1016/j.clinimag.2020.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the effect of iron oxide particle deposition on follow-up mammograms and MRI examinations of patients who underwent sentinel lymph node detection with iron oxide particles. MATERIALS AND METHODS Two hundred and eighteen patients who had sentinel lymph node biopsy (SLNB) with iron oxide particles were evaluated. Follow-up MRI and mammography were available in 36 and 69 cases respectively. MRI examinations were evaluated for ferromagnetic artifacts that were graded as follows: 0 = No artifact, 1 = Focal area, 2 = Segmental and 3 = Regional signal void artifact. Mammography artifacts were evaluated for the presence of dense particles. Pearson's chi-square test was used for statistical analyses and P < 0.05 was accepted as significant. RESULTS MRI artifact grading was as follows: Grade 0: 11 (30.6%), Grade 1: 14 (38.9%), Grade 2: 3 (8.3%), and Grade 3: 8 (22.2%). The grade of artifacts differed across surgery types (P = 0.019). Grade 3 artifacts were higher in breast conserving cases whereas Grade 0 was more frequent in subcutaneous mastectomy cases. Three out of 69 (4.4%) cases who had follow-up mammography had artifacts due to iron oxide particle accumulation which presented as Grade 3 MRI artifact in all. CONCLUSION Accumulation of iron oxide particles after SLNB with paramagnetic tracers causes artifacts on follow-up MRI examinations in half of the cases but it is significantly low in mammograms. These artifacts may be confusing in the evaluation of the images. Radiologists must be aware of these tracers and their artifacts whereas patients should be questioned for the type of SLNB before a follow-up examination.
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12
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Mariscal Martínez A, Vives Roselló I, Salazar Gómez A, Catanese A, Pérez Molina M, Solà Suarez M, Pascual Miguel I, Blay Aulina L, Ríos Gozálvez C, Julián Ibáñez JF, Rodríguez Martínez P, Martínez Román S, Margelí Vila M, Luna Tomás MA. Advantages of preoperative localization and surgical resection of metastatic axillary lymph nodes using magnetic seeds after neoadjuvant chemotherapy in breast cancer. Surg Oncol 2020; 36:28-33. [PMID: 33285433 DOI: 10.1016/j.suronc.2020.11.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the safety and effectiveness of magnetic seeds in preoperative localization and surgical dissection of metastatic axillary lymph nodes (LN+) in breast cancer patients with axillary involvement, after neoadjuvant chemotherapy (NAC). In addition, to assess the impact of targeted axillary dissection (TAD) in reducing the rate of false negatives (FN) in sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS A cross-sectional prospective cohort study was conducted from April 2017 to September 2019, including breast cancer patients with axillary lymph node involvement treated with NAC. Prior to NAC, the LN+ were marked by ultrasound-guided clip insertion. After NAC, a magnetic seed (Magseed®) was inserted in the clip-marked lymph node (MLN). During surgery, the MLN was located and removed with the aid of a magnetic detection probe (Sentimag®) and the sentinel lymph node was removed. Axillary lymph node dissection (ALND) was used to determine the rate of FN for SLNB alone and the combination of SLNB and MLN dissection, called TAD. RESULTS The study included 29 patients (mean age, 55; range, 30-78 years). Selective preoperative localization and surgical dissection were successful for all 30 MLNs (100%). The MLN corresponded to the SLN in 50% of cases. After ALND, there were 21.4% (3/14) FN with SLNB alone and 5.9% (1/17) with TAD. CONCLUSIONS Following NAC, selective surgical removal of MLN by preoperative localization using magnetic seeds is a safe and effective procedure with a success rate of 100%. Adding TAD reduces the rate of FN associated with SLNB alone.
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Affiliation(s)
- Antonio Mariscal Martínez
- Breast Diagnostic Imaging Unit (BDIU) Department of Radiology, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Barcelona, Spain.
| | | | - Angela Salazar Gómez
- Breast Diagnostic Imaging Unit (BDIU) Department of Radiology, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Barcelona, Spain
| | - Alessandro Catanese
- Breast Diagnostic Imaging Unit (BDIU) Department of Radiology, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Barcelona, Spain
| | - Mariola Pérez Molina
- Breast Diagnostic Imaging Unit (BDIU) Department of Radiology, Hospital Universitari Germans Trias i Pujol (HUGTiP), Badalona, Barcelona, Spain
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13
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Tan MP, Bi Z, Ong EMW. The 'twinkle' artifact - A novel method of clip identification to facilitate targeted axillary surgery following neoadjuvant chemotherapy in breast cancer patients. Clin Imaging 2020; 68:36-44. [PMID: 32563723 DOI: 10.1016/j.clinimag.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/30/2020] [Accepted: 06/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A targeted surgical approach which accurately determines axillary status after neoadjuvant chemotherapy (NAC) may allow appropriate de-escalation of surgical treatment. It is postulated that the combined use of a particular marker clip, ULTRACOR®TWIRL™ (Bard, Inc.), and specific ultrasound settings for its identification, may overcome the challenges of pre-operative localisation with size diminution of nodes following NAC. Hence, this feasibility study was performed. METHODS Three patients with locally advanced breast cancer (LABC), who had the Twirl marker clip placed in biopsy-proven metastatic axillary lymph nodes and completed treatment were included in this preliminary study. Preoperative sonographic identification of the clip and associated node was done on the day of surgery, confirmed by eliciting the 'twinkle' artifact, followed by hookwire localisation and resection. The 'twinkle' artifact was demonstrated within each specimen after resection. RESULTS All three patients who completed treatment for LABC had successful identification and resection of clipped node aided by the 'twinkle artifact'. CONCLUSION The 'twinkle' artifact is a novel and useful aid in identifying the Twirl™ clip marking a lymph node in the post-NAC setting, with the potential to be used intraoperatively.
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Affiliation(s)
- Mona P Tan
- Breast Surgical Oncology, MammoCare, Singapore, 38 Irrawaddy Road, #06-21, Singapore 329563, Republic of Singapore.
| | - Zhen Bi
- The Orchard Imaging Centre, Asiamedic Limited, Singapore, Republic of Singapore
| | - Eugene M W Ong
- Department of Radiology, Mount Elizabeth Novena Hospital, Singapore, Republic of Singapore
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Malter W, Holtschmidt J, Thangarajah F, Mallmann P, Krug B, Warm M, Eichler C. First Reported Use of the Faxitron LOCalizer™ Radiofrequency Identification (RFID) System in Europe - A Feasibility Trial, Surgical Guide and Review for Non-palpable Breast Lesions. In Vivo 2020; 33:1559-1564. [PMID: 31471405 DOI: 10.21873/invivo.11637] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/20/2019] [Accepted: 06/27/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIM The problem of adequately marking any given lesion within a breast surgical site is commonly solved by introducing a titanium clip. However, clip dislocation and/or stereotactic hook-wire dislocation are common problems. An ideal solution would be a clip that can be easily found without the use of stereotactic intervention. This work reviews the available data on radiofrequency identification devices (RFID) in breast surgery, reports initial experience data in Europe and discusses surgical pitfalls, advantages and disadvantages. PATIENTS AND METHODS This study represents a single center, consecutively recruited, initiation trial with subsequent surgeon questionnaire for the first institution in Europe to report Faxitron LOCalizer™ chip data. Four patients with non-palpable tumors were marked with the system and were correlated via mammography, pre- and intra-operative ultrasound and pathology. Data were then compared to available literature and a literature review was added. RESULTS The four patients marked with this RFID system, displayed a 100% success location rate at a 0% complication rate. Surgeons evaluated the new system as being safe to use and only slightly more difficult to place compared to a standard clip. A significant improvement in ultrasound localization and intraoperative localization was also reported for the LOCalizer™ system when compared to a standard titanium clip. CONCLUSION This trial added a small number of consecutively recruited patients to an existing number of available data, resulting in a total of 121 evaluated and reviewed Faxitron LOCalizer™ marked non-palpable in-breast lesions worldwide.
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Affiliation(s)
- Wolfram Malter
- University of Cologne, Faculty of Faculty of Medicine and University Hospital Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - Johannes Holtschmidt
- University of Cologne, Faculty of Faculty of Medicine and University Hospital Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - Fabinshy Thangarajah
- University of Cologne, Faculty of Faculty of Medicine and University Hospital Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - Peter Mallmann
- University of Cologne, Faculty of Faculty of Medicine and University Hospital Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - Barbara Krug
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Radiology, Cologne, Germany
| | - Mathias Warm
- University of Cologne, Faculty of Faculty of Medicine and University Hospital Cologne, Department of Obstetrics and Gynecology, Cologne, Germany.,Breast Cancer Center, Municipal Hospital Holweide, Cologne, Germany
| | - Christian Eichler
- University of Cologne, Faculty of Faculty of Medicine and University Hospital Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
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15
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Yuan Q, Wu G, Xiao SY, He Y, Wang K, Zhang D. Surgical Management of the Axilla in Breast Cancer Patients with Negative Sentinel Lymph Node: A Method to Reduce False-Negative Rate. World J Surg 2019; 43:1047-1053. [PMID: 30478688 DOI: 10.1007/s00268-018-4865-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND False-negative rate (FNR) of sentinel lymph node dissection (SLND) has not been eliminated. The study was conducted to optimize the surgical resection of axilla in patients with negative sentinel lymph node (SLN) for the purpose of eradicating false-negative (FN) events of SLND. METHODS A total of 312 clinically node-negative patients without neoadjuvant therapy underwent SLND with indocyanine green (ICG), methylene blue and the combination of ICG and methylene blue. Axillary dissection was performed subsequently regardless of the status of SLN. Lymph nodes were sent for pathological examination separately by serial resection every 0.5 cm away from marginally visualized SLNs. RESULTS SLND was successfully conducted in 98.1% (306/312) of patients using methylene blue, ICG, and its combination. Further examination revealed 97 true-positive, 189 true-negative, and 13 FN results. The overall FNR was 11.8% (13/110). A horizontal line 1.5 cm away from the superior vSLN and a vertical line 1.5 cm away from the medial vSLN formed a zone of lower outer quadrant (LOQ) in axilla. Surgical resection of LOQ 'en bloc' showed a FNR of zero. CONCLUSIONS The surgical management of axilla may benefit negative SLN patients with potential nodal involvement, reducing the FNR of SLND to zero. TRIAL REGISTRATION NUMBER AND AGENCY This study was registered with the Chinese Clinical Trial Registry (ChiCTR1800014247).
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Affiliation(s)
- Qianqian Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China.
| | - Shu-Yuan Xiao
- Wuhan University Center for Pathology and Molecular Diagnostics, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
- Department of Pathology, University of Chicago, Chicago, IL, 60637, USA
| | - Yukun He
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Kun Wang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, People's Republic of China
| | - Dan Zhang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, People's Republic of China
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Tamayo Carabaño D, Álvarez Pérez R, De Bonilla Damiá Á, Acevedo Bañez I, Pachón Garrudo V, Jiménez-Hoyuela García J. Sentinel lymph node biopsy in N+ breast cancer with conversion into N0 after neoadjuvant chemotherapy. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Zeitoun J, Babin G, Lebrun JF. [Sentinel node and breast cancer: A state-of-the-art in 2019]. ACTA ACUST UNITED AC 2019; 47:522-526. [PMID: 30959186 DOI: 10.1016/j.gofs.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Indexed: 01/09/2023]
Abstract
Since 1994 and Giuliano's description of sentinel lymph node technique, this procedure has considerably improved and is nowadays, one of the essential pillars in the management of breast cancer. Neoadjuvant chemotherapy (NAC) is effective on regional control, especially on axillary lymph node. Various learned societies recommend that the initial proved GS can be realized before (CNGOF 2010, Saint-Paul de Vence 2013, ESMO 2015, St-Gallen 2015, NCCN 2016) or after (ASCO 2014, ESMO 2015, Saint-Gallen 2015) CNA when the patient is considered like N0. In patients with initial lymph node involvement, GS searching it is not yet recommended. SLN detection before NAC remains an important prognostic factor especially in N+ patients before surgery. The purpose of this article was a reviewing of medical literature regarding possible indications for SLN detection and axillary dissection in patients with NAC according to sentinel lymph node status. The secondary objective was to put forward different perspectives and studies dealing with this subject. The complete pathological response appears to be an important selection criterion for proposing SLN to these patients and avoiding a "useless" AD. It is important to include patients in the trials to make recommendations progress on SLN after NAC and avoid a rate of uninjured AD.
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Affiliation(s)
- J Zeitoun
- Faculté de médecine de Caen, avenue Côte-de-Nacre, 14000 Caen, France; Centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France.
| | - G Babin
- Centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - J F Lebrun
- Centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
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18
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Tamayo Carabaño D, Álvarez Pérez R, De Bonilla Damiá Á, Acevedo Bañez I, Pachón Garrudo VM, Jiménez-Hoyuela García JM. Sentinel lymph node biopsy in N+ breast cancer with conversion into N0 after neoadjuvant chemotherapy. Rev Esp Med Nucl Imagen Mol 2018; 38:140-146. [PMID: 30594445 DOI: 10.1016/j.remn.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/14/2018] [Accepted: 11/23/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Sentinel lymph node biopsy (SLNB) usefulness in breast carcinoma N+ converted to N0 after neoadjuvant chemotherapy (NC). MATERIAL AND METHODS Descriptive study including 16 females with infiltrating carcinoma with lymphatic metastasis confirmed by biopsy, leaving a metallic marker (MM) in pathological lymph nodes (LN). All patients underwent NC reaching a complete radiological response in LN. Lymphoscintigraphy was performed after 99mTc nanocoloid injection, obtaining planar images and SPECT/CT. Lymphatic drainage and concordance of sentinel node (SN) with MM was analyzed. RESULTS SN was visualized in lymphoscintigraphy in 93.7% of cases. The SN coincided with the MM in 12/15 cases on SPECT/CT. The SLNB technique was completed on 14/16 patients, intraoperatively locating the GC in all of them. The SN was negative in 10 cases, 3 cases presented macrometastases and 1 micrometastases. Axillary lymphadenectomy (AL) was performed in a case of macrometastasis with>15,000cp/μARNm CK-19, absence of drainage and in one case that showed no coincidence with the MM due different Berg's level location. These last two cases presented lymph node metastasis. In the other two cases with not coincidence between the SN and the MM, a total of 4 lymph nodes were removed, showing no evidence of metastasis. Patients without AL were followed up for an average of 10 months (range 6-17), with no evidence of lymph node involvement. CONCLUSION SLNB in breast cancer with conversion into N0 after neoadjuvant treatment is a technique with good results and a low false negative rate.
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Affiliation(s)
- D Tamayo Carabaño
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - R Álvarez Pérez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Á De Bonilla Damiá
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - I Acevedo Bañez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - V M Pachón Garrudo
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
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Green M, Neamonitou F, Vidya R. Conservative Management of Positive Axilla After Neoadjuvant Systemic Therapy-The Need for, and Review of, Techniques Used for Lymph Node Localization. Clin Breast Cancer 2018; 18:e739-e742. [PMID: 29983380 DOI: 10.1016/j.clbc.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 01/25/2023]
Abstract
Involvement of axillary lymph nodes is an important prognostic factor in relationship to the management of breast cancer. However, the use of neoadjuvant systemic therapy is widespread in the treatment of positive axilla and such treatment leads to downstaging of axillary disease. Hence, the role of targeted axillary lymph node biopsy appears to play a vital role after primary systemic therapy. Given that this is a relatively novel approach, we have discussed the evidence for this approach and the different techniques currently available for localization of biopsy-proven metastatic axillary lymph nodes. We have also highlighted the need for universal guidelines for conservative management of positive axilla after systemic therapy.
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Affiliation(s)
- Matthew Green
- Department of Breast Surgery, New Cross Hospital, Royal Wolverhampton NHS, Wolverhampton, United Kingdom.
| | - Foteini Neamonitou
- Department of Breast Surgery, New Cross Hospital, Royal Wolverhampton NHS, Wolverhampton, United Kingdom
| | - Raghavan Vidya
- Department of Breast Surgery, New Cross Hospital, Royal Wolverhampton NHS, Wolverhampton, United Kingdom
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