Node-Positive Patients Treated with Neoadjuvant Chemotherapy Can Be Spared Axillary Lymph Node Dissection with Wireless
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ORIGINAL ARTICLE – BREAST ONCOLOGY
Node-Positive Patients Treated with Neoadjuvant Chemotherapy Can Be Spared Axillary Lymph Node Dissection with Wireless Non-Radioactive Localizers Alison Laws, MD1, Kayla Dillon, BA1, Bridget N. Kelly, BA1, Olga Kantor, MD, MS1, Kevin S. Hughes, MD1, Michele A. Gadd, MD1, Barbara L. Smith, MD, PhD1, Leslie R. Lamb, MD2, and Michelle Specht, MD1 1
Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA ; 2Department of Radiology, Massachusetts General Hospital, Boston, MA
ABSTRACT Background. Targeted axillary dissection (TAD) involves sentinel lymph node biopsy (SLNB) and excision of a biopsy-proven node marked by a clip. This study evaluates the feasibility of non-radioactive wireless localizers for targeted excision of clipped axillary lymph nodes. Methods. We identified biopsy-proven, node-positive breast cancer patients treated with neoadjuvant therapy (NAT) and TAD from 2016 to 2020, and included those with a clipped node localized using SAVI SCOUT, Magseed, or RFID Tag. Primary outcome measures were (1) successful localization (ultrasound or mammographic-guided placement \ 10 mm from target), and (2) retrieval of the clipped node during TAD, documented by specimen radiography or gross visualization. Secondary outcomes included rates of completion axillary lymph node dissection (cALND) and complications. Results. Overall, 57 patients were included; 1 (1.8%) patient had no clip visible at the time of localization, and no radiographic confirmation of clip placement at the time of biopsy, and was therefore excluded. In the remaining 56 patients, localization was successful in 53 (94.6%) patients and the clipped node was retrieved during TAD in 51 (91.1%) patients. Twenty-three of 27 (85.2%) ypN0 patients were spared cALND; 3 (11.1%) patients had cALND for failed clipped node retrieval during TAD, and
Ó Society of Surgical Oncology 2020 First Received: 27 May 2020 Accepted: 30 June 2020 M. Specht, MD e-mail: [email protected]
1 (3.7%) for false-positive frozen section. In patients with TAD alone, the rates of axillary seroma and infection were 20.0% and 8.6%, respectively. Conclusions. Wireless non-radioactive localizers are feasible for axillary localization after NAT, with high success rates of retrieving clipped nodes. The lack of signal decay is an advantage of these devices, allowing flexibility in timing of placement. Keywords Node positive breast cancer Sentinel lymph node biopsy Targeted axillary dissection Neoadjuvant chemotherapy Lymph node localization Axillary pathologic complete response (pCR) is achieved in approximately 40% of node-positive breast cancer patients after neoadjuvant chemotherapy (NAC), with higher rates in triple-negative and human epidermal growth factor receptor 2 (HER)-positive (HER2 ?) subtypes.1–4 Clinical trials have demonstrated acceptable false negative rates (FNR) of sentinel lymph node biopsy (SLNB) for axillary staging post-NAC,3,5,6 although the FNR is improved when the biopsy-proven metastatic lymph
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