ASO Author Reflections: Non-radioactive Sentinel Node Localization with Superparamagnetic Iron Oxide in Clinically Node-
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Non-radioactive Sentinel Node Localization with Superparamagnetic Iron Oxide in Clinically Node-Negative Breast Cancer Patients: A Possibility for Improvement of the Care Pathway Maria Margarete Karsten, MD, Sina Shams
, and Friedrich Ku¨hn
Department of Gynecology, Corporate Member of Freie Universita¨t Berlin, Humboldt-Universita¨t zu Berlin and Berlin Institute of Health, Charite´–Universita¨tsmedizin Berlin, Berlin, Germany
PAST
PRESENT
Sentinel node biopsy (SNB) was first established in the therapy of early-stage melanoma,1 then subsequently adopted for other oncologic entities. Currently, it is a pivotal part of the staging and therapy for breast cancer patients. In this context, various agents for sentinel lymph node localization have proven suitable for reaching high detection rates and low false-negative rates.2 Radioactive localization using technetium99 (Tc99) in combination with blue dye or as a single tracer has long been considered the ‘‘gold standard.’’ However due to the short half-life of technetium, injections need to be scheduled close to surgery. Radiation protection measures, and in Germany additional lymphoscintigraphy, are mandatory and extend the preparation time. A more flexible schedule and thus an increase in patient comfort might be achieved by using superparamagnetic iron oxide (SPIO). Proven equivalent to Tc99 for primary SNB by multiple meta-analyses,2, 3 SPIO can be administered up to 7 days before surgery.
This study enrolled 59 patients at Charite´–Universita¨tsmedizin Berlin to investigate the impact of SPIO use for SNB on the care process, reimbursement, surgical time, and patient comfort compared with 99Tc.4 The preoperative preparation time was significantly shorter for the SPIO group (SPIO, 5.4 ± 1.3 min vs TC99, 82 ± 20 min; p \ 0.0001), even with omission of the time spent for lymphoscintigraphy (TC99, 54.4 ± 13.6 min; p \ 0.0001). Also, the duration of the sentinel lymph node extraction was slightly shorter (SPIO, 5 min [range, 3–15 min] vs TC99, 10 min [range, 7–15 min]; p = 0.151). With SPIO, the duration of the whole SNB procedure also was shorter (SPIO, 9 min [range, 4–15 min] vs TC99, 10 min [range, 7–15 min]; p = 0.412) despite the fact that the iron-based system was a new method at our institution. Concerning pain assessment and reimbursement, the study could not detect any significant differences between the two groups. The study was limited by its small sample size, non-randomized group allocation, and variation in surgical procedures (mastectomy and breast-conserving surgery). In hindsight, detailed patient-reported experience measurements would have been favorable for examination of patient comfort.
Maria Margarete Karsten and Sina Shams have contributed equally to this work. Ó The Author(s) 2020 First Received: 22 October 2020 Accepted: 22 October 2020 M. M. Karsten, MD e-mail: [email protected]
FUTURE The aforementioned findings show that SPIO-based sentinel-node localization facilitates a
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