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Annals of Surgical Oncology

, Volume 22, Issue 2, pp 377–382 | Cite as

Initial Results with Preoperative Tattooing of Biopsied Axillary Lymph Nodes and Correlation to Sentinel Lymph Nodes in Breast Cancer Patients

  • Nicole Choy
  • Jafi Lipson
  • Catherine Porter
  • Michael Ozawa
  • Anne Kieryn
  • Sunita Pal
  • Jennifer Kao
  • Long Trinh
  • Amanda Wheeler
  • Debra Ikeda
  • Kristin Jensen
  • Kimberly Allison
  • Irene WapnirEmail author
Breast Oncology

Abstract

Background

Pretreatment evaluation of axillary lymph nodes (ALNs) and marking of biopsied nodes in patients with newly diagnosed breast cancer is becoming routine practice. We sought to test tattooing of biopsied ALNs with a sterile black carbon suspension (Spot™). The intraoperative success of identifying tattooed ALNs and their concordance to sentinel nodes was determined.

Methods

Women with suspicious ALNs and newly diagnosed breast cancer underwent palpation and/or ultrasound-guided fine needle aspiration or core needle biopsy, followed by injection of 0.1 to 0.5 ml of Spot™ ink into the cortex of ALNs and adjacent soft tissue. Group I underwent surgery first, and group II underwent neoadjuvant therapy followed by surgery. Identification of black pigment and concordance between sentinel and tattooed nodes was evaluated.

Results

Twenty-eight patients were tattooed, 16 in group I and 12 in group II. Seventeen cases had evidence of atypia or metastases, 8 (50 %) in group I and 9 (75 %) in group II. Average number of days from tattooing to surgery was 22.9 (group I) and 130 (group II). Black tattoo ink was visualized intraoperatively in all cases, except one case with microscopic black pigment only. Fourteen group I and 10 group II patients had black pigment on histological examination of ALNs. Sentinel nodes corresponded to tattooed nodes in all except one group I patient with a tattooed non-sentinel node.

Conclusion

Tattooed nodes are visible intraoperatively, even months later. This approach obviates the need for additional localization procedures during axillary staging.

Keywords

Sentinel Node Sentinel Lymph Node Biopsy Fine Needle Aspiration Axillary Lymph Node Dissection Core Needle Biopsy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Nicole Choy
    • 1
  • Jafi Lipson
    • 2
  • Catherine Porter
    • 1
  • Michael Ozawa
    • 3
  • Anne Kieryn
    • 1
  • Sunita Pal
    • 2
  • Jennifer Kao
    • 2
  • Long Trinh
    • 2
  • Amanda Wheeler
    • 1
  • Debra Ikeda
    • 2
  • Kristin Jensen
    • 3
  • Kimberly Allison
    • 3
  • Irene Wapnir
    • 1
    Email author
  1. 1.Department of SurgeryStanford University School of Medicine and the Stanford Cancer InstituteStanfordUSA
  2. 2.Department of RadiologyStanford University School of Medicine and the Stanford Cancer InstituteStanfordUSA
  3. 3.Department of PathologyStanford University School of Medicine and the Stanford Cancer InstituteStanfordUSA

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