Avoiding unnecessary sentinel lymph node biopsy with the use of superparamagnetic iron oxide mapping agents (Magtrace®) in breast surgery

BACKGROUND

Superparamagnetic iron oxide (SPIO) (Magtrace®) is a non-radioactive liquid tracer that can stay in the sentinel lymph nodes for 30 days. Injection of SPIO at time of primary breast surgery where upfront sentinel lymph node biopsy (SLNB) is not immediately indicated allows for a return to theatre if pathology then identifies invasive disease. SLNB is associated with paraesthesia, pain, seroma formation and lymphoedema risk. Hence, our study aims to assess the use of SPIO to avoid upfront SLNB in breast surgery for ductal carcinoma in situ (DCIS) and prophylaxis.

METHODS

Retrospective single-centre study of consecutive patients who underwent injection of SPIO tracer at time of primary breast surgery to avoid upfront SLNB at Chris O'Brien Lifehouse, Sydney, NSW, Australia over a 10-month period.

RESULTS

SPIO was injected 38 times, with 34 at time of mastectomy and four cases at time of wide local excision. The indication for surgery was DCIS in 18 cases, risk reduction in 17 cases and other indications in three patients. Six cases (15.8%) required delayed SLNB (D-SLNB) due to the finding of invasive disease on post-operative histopathology. All patients who underwent D-SLNB had nodes successfully localized with SPIO.

CONCLUSION

In our cohort, 84.2% of cases were able to avoid upfront SLNB, and hence avoid the associated complications of SLNB. SPIO injection was successful in localizing the SLN in all cases at time of surgery for D-SLNB. This technique was safe with few associated complications.

Outcomes of adrenalectomy performed in regional New South Wales, Australia

BACKGROUND

Centralization of subspeciality procedures in Australia is difficult due to a vast geographical span and in the appropriate patient group, surgery in regional centres should be considered. Our study reviews the safety of adrenalectomy performed at a low-volume regional centre in regards to length of hospital admission, operative time, complication rate and conversion to open rate.

METHOD

A retrospective cross-sectional study was performed of consecutive patients undergoing laparoscopic or open adrenalectomy over a nine-year period (2012-2021) at Dubbo Base Hospital, a regional hospital in Western New South Wales, Australia. These operations were all performed by a single Urologist.

RESULTS

Thirteen patients underwent adrenalectomy at our institution over the nine-year period. The mean age was 51.7 years (SD10.1). There were seven women (53.8%) and six men (46.2%). Seven patients were considered low risk, four patients were medium risk and two patients were high risk as per the Charlson Comorbidity Index. All of our patients were overweight, with mean body mass index of 34.6 (SD 6.9). Mean operating time was 133.5 min (SD 36.3) and mean length of stay was 3.8 days (SD 2.2). There was one conversion to open (8.3%). Three patients (23.1%) had complications, of these complications, one was Clavien-Dindo grade II, and one was Clavien-Dindo grade IIIb. There were no mortalities.

CONCLUSION

Our outcomes demonstrate that adrenalectomy in our low volume regional centre is safe with comparable outcomes of operative time, length of hospital stay and complication rate with other centres.