Feasibility of Charcoal Tattooing of Cytology-Proven Metastatic Axillary Lymph Node at Diagnosis and Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients
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Purpose Sentinel lymph node biopsy (SLNB) can be performed when node-positive disease is converted to node-negative status after neoadjuvant chemotherapy (NCT). Tattooing nodes might improve accuracy but supportive data are limited. This study aimed to investigate the feasibility of charcoal tattooing metastatic axillary lymph node (ALN) at presentation followed by SLNB after NCT in breast cancers. Materials and Methods Twenty patients with cytology-proven node metastases prospectively underwent charcoal tattooing at diagnosis. SLNB using dual tracers and axillary surgery after NCT were then performed. The detection rate of tattooed node and diagnostic performance of SLNB were analyzed. Results All patients underwent charcoal tattooing without significant morbidity. Sentinel and tattooed nodes could be detected during surgery after NCT. Nodal pathologic complete response was achieved in 10 patients. Overall sensitivity, false-negative rate (FNR), negative predictive value, and accuracy of hot/blue SLNB were 80.0%, 20.0%, 83.3%, and 90.0%, respectively. Retrieving more nodes and favorable nodal response were associated with improved performance. The best accuracy was observed when excised tattooed node was calculated together (FNR, 0.0%). Cold/non-blue tattooed nodes of five patients were removed during non-sentinel axillary surgery but clinicopathological parameters did not differ compared to patients with hot/blue tattooed node detected during SLNB, suggesting the importance of the tattooing procedure itself to improve performance. Conclusion Charcoal tattooing of cytology-confirmed metastatic ALN at presentation is technically feasible and does not limit SLNB after NCT. The tattooing procedure without additional preoperative localization is advantageous for improving the diagnostic performance of SLNB in this setting.
Abstract
Purpose Sentinel lymph node biopsy (SLNB) can be performed when node-positive disease is converted to node-negative status after neoadjuvant chemotherapy (NCT). Tattooing nodes might improve accuracy but supportive data are limited. This study aimed to investigate the feasibility of charcoal tattooing metastatic axillary lymph node (ALN) at presentation followed by SLNB after NCT in breast cancers. Materials and Methods Twenty patients with cytology-proven node metastases prospectively underwent charcoal tattooing at diagnosis. SLNB using dual tracers and axillary surgery after NCT were then performed. The detection rate of tattooed node and diagnostic performance of SLNB were analyzed. Results All patients underwent charcoal tattooing without significant morbidity. Sentinel and tattooed nodes could be detected during surgery after NCT. Nodal pathologic complete response was achieved in 10 patients. Overall sensitivity, false-negative rate (FNR), negative predictive value, and accuracy of hot/blue SLNB were 80.0%, 20.0%, 83.3%, and 90.0%, respectively. Retrieving more nodes and favorable nodal response were associated with improved performance. The best accuracy was observed when excised tattooed node was calculated together (FNR, 0.0%). Cold/non-blue tattooed nodes of five patients were removed during non-sentinel axillary surgery but clinicopathological parameters did not differ compared to patients with hot/blue tattooed node detected during SLNB, suggesting the importance of the tattooing procedure itself to improve performance. Conclusion Charcoal tattooing of cytology-confirmed metastatic ALN at presentation is technically feasible and does not limit SLNB after NCT. The tattooing procedure without additional preoperative localization is advantageous for improving the diagnostic performance of SLNB in this setting.
참고문헌 (30)
- Lyman GH, "Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update", J Clin Oncol, 35, pp.561~564 (2017)
- Bromham N, "Axillary treatment for operable primary breast cancer", Cochrane Database Syst Rev, 1 (2017)
- Park S, "Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with cytologically proven node-positive breast cancer at diagnosis", Ann Surg Oncol, 20, pp.2858~2865 (2013)[DOI]
- Pilewskie M, "Axillary nodal management following neoadjuvant chemotherapy: a review", JAMA Oncol, 3, pp.549~555 (2017)[DOI]
- Jatoi I, "De-escalation of axillary surgery in early breast cancer", Lancet Oncol, 17, pp.e430~e441 (2016)[DOI]
- Kuehn T, "Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study", Lancet Oncol, 14, pp.609~618 (2013)[DOI]
- Boughey JC, "Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial", JAMA, 310, pp.1455~1461 (2013)[DOI]
- Boileau JF, "Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study", J Clin Oncol, 33, pp.258~264 (2015)
- Gradishar WJ, "Invasive breast cancer version 1.2016, NCCN clinical practice guidelines in oncology", J Natl Compr Canc Netw, 14, pp.324~354 (2016)[DOI]
- Caudle AS, "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, 34, pp.1072~1078 (2016)[DOI]
- Choy N, "Initial results with preoperative tattooing of biopsied axillary lymph nodes and correlation to sentinel lymph nodes in breast cancer patients", Ann Surg Oncol, 22, pp.377~382 (2015)[DOI]
- Shin K, "Radiologic mapping for targeted axillary dissection: needle biopsy to excision", AJR Am J Roentgenol, 207, pp.1372~1379 (2016)[DOI]
- Edge SB, "AJCC cancer staging manual. 7th ed" (2010), Springer
- Hammond ME, "American Society of Clinical Oncology", College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer, 2010, pp.28, 2784~2795
- Wolff AC, "Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology", College of American Pathologists clinical practice guideline update, 2013, pp.31, 3997~4013
- Weaver DL, "Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale", Mod Pathol, 23(Suppl 2), pp.S26~S32 (2010)[DOI]
- Glechner A, "Sentinel lymph node dissection only versus complete axillary lymph node dissection in early invasive breast cancer: a systematic review and meta-analysis", Eur J Cancer, 49, pp.812~825 (2013)[DOI]
- Mastrangelo S, "Surgical management of the axilla in breast cancer", Am Surg, 82, pp.475~486 (2016)
- Rubio IT, "Sentinel lymph node biopsy after neoadjuvant treatment in breast cancer: work in progress", Eur J Surg Oncol, 42, pp.326~332 (2016)[DOI]
- van Nijnatten TJ, "The diagnostic performance of sentinel lymph node biopsy in pathologically confirmed node positive breast cancer patients after neoadjuvant systemic therapy: a systematic review and meta-analysis", Eur J Surg Oncol, 41, pp.1278~1287 (2015)[DOI]
- El Hage Chehade H, "Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients", Am J Surg, 212, pp.969~981 (2016)[DOI]
- King TA, "Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy", Nat Rev Clin Oncol, 12, pp.335~343 (2015)[DOI]
- Mamtani A, "How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study", Ann Surg Oncol, 23, pp.3467~3474 (2016)[DOI]
- Boughey JC, "Axillary ultrasound after neoadjuvant chemotherapy and its impact on sentinel lymph node surgery: results from the American College of Surgeons Oncology Group Z1071 Trial (Alliance)", J Clin Oncol, 33, pp.3386~3393 (2015)[DOI]
- Enokido K, "Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with an initial diagnosis of cytology-proven lymph node-positive breast cancer", Clin Breast Cancer, 16, pp.299~304 (2016)[DOI]
- Lyman GH, "American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer", J Clin Oncol, 23, pp.7703~7720 (2005)[DOI]
- Amersi F, "Management of the axilla", Hematol Oncol Clin North Am, 27, pp.687~702 (2013)[DOI]
- Boughey JC, "Identification and resection of clipped node decreases the false-negative rate of sentinel lymph node surgery in patients presenting with node-positive breast cancer (T0-T4, N1-N2) who receive neoadjuvant chemotherapy: results From ACOSOG Z1071 (Alliance)", Ann Surg, 263, pp.802~807 (2016)[DOI]
- Kawase K, "Use of lymphoscintigraphy defines lymphatic drainage patterns before sentinel lymph node biopsy for breast cancer", J Am Coll Surg, 203, pp.64~72 (2006)[DOI]
- Ando J, "Preoperative diagnosis of the axillary arch with multidetector row computed tomography and the axillary arch in association with anatomical problems of sentinel lymph node biopsy", Breast Cancer, 17, pp.3~8 (2010)[DOI]
