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Annals of Surgical Oncology

, Volume 24, Issue 10, pp 3011–3016 | Cite as

Localizing the Clipped Node in Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Chemotherapy: Early Learning Experience and Challenges

  • Toan T. Nguyen
  • Tina J. Hieken
  • Katie N. Glazebrook
  • Judy C. BougheyEmail author
Breast Oncology

Abstract

Background

Placement of a clip in the positive node in patients presenting with node-positive breast cancer treated with neoadjuvant chemotherapy (NAC) allows resection of the clipped node at SLN surgery and improves the accuracy of surgical staging. We sought to evaluate our experience with SLN surgery with resection of the clipped node since incorporation into our practice.

Methods

With Institutional Review Board approval, we evaluated all breast cancer patients with a percutaneous biopsy-positive axillary lymph node, clipped at the time of diagnosis, who underwent NAC followed by surgery.

Results

Fifty-six node-positive patients were identified. Eighteen patients (32.1%) underwent axillary dissection without sentinel lymph node (SLN) surgery, and 38 patients underwent SLN surgery (18 patients underwent SLN surgery alone, and 20 patients underwent SLN surgery and axillary lymph node dissection). In 25 patients, preoperative localization of the clipped node with an 125I radioactive seed was attempted. This was performed by ultrasound guidance in 18 cases (72%), computed tomography (CT) guidance in two cases (8%), and was unable to be localized in five cases (20%). In all 20 seed-localized cases, the seed and the clipped node were resected along with additional SLNs. In 14 patients without seed localization (nine not attempted, five unable to be localized), the clipped node was resected in 11 cases (79%)—as one of the SLNs (6), by intraoperative ultrasound (4), or by palpation (1). Overall, the clipped node was resected in 31/34 (91%) cases.

Conclusion

Preoperative ultrasound localization of the clipped node was successful in 72% of cases. Alternatively, the clipped node can be identified by preoperative CT, routine SLN surgery, intraoperative ultrasound, or palpation.

Notes

Disclosures

None.

References

  1. 1.
    Al-Hilli Z, Hieken TJ, Boughey JC. Axillary ultrasound in the management of the newly diagnosed breast cancer patient. Breast J. 2015;21(6):634–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Dominici LS, Negron Gonzalez VM, Buzdar AU, et al. Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2-positive breast cancer. Cancer. 2010;116(12):2884–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kuerer HM, Sahin AA, Hunt KK, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg. 1999;230(1):72–8.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Boughey JC, McCall LM, Ballman KV, et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg. 2014;260(4):608–14.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Buzdar AU, Ibrahim NK, Francis D, et al. Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 2005;23(16):3676–85.CrossRefPubMedGoogle Scholar
  6. 6.
    Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) Clinical Trial. JAMA. 2013;310(14):1455–61.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-Lymph-Node Biopsy in Patients With Breast Cancer Before and After Neoadjuvant Chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14(7):609–18.CrossRefPubMedGoogle Scholar
  8. 8.
    Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC Study. J Clin Oncol. 2015;33(3):258–64.CrossRefPubMedGoogle Scholar
  9. 9.
    Boughey JC, Ballman KV, Le-Petross HT, et al. 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. 2016;263(4):802-7.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology, Breast Cancer. Version 2.2017. www.nccn.org. Accessed 17 Apr 2017.
  11. 11.
    Caudle AS, Yang WT, Krishnamurthy S, et al. 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. 2016;34(10):1072–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Diego EJ, McAuliffe PF, Soran A, et al. Axillary staging after neoadjuvant chemotherapy for breast cancer: a pilot study combining sentinel lymph node biopsy with radioactive seed localization of pre-treatment positive axillary lymph nodes. Ann Surg Oncol. 2016;23(5):1549–53.CrossRefPubMedGoogle Scholar
  13. 13.
    Nathanson SD, Burke M, Slater R, Kapke A. Preoperative Identification of the Sentinel Lymph Node in Breast Cancer. Ann Surg Oncol. 2007;14(11):3102–10.CrossRefPubMedGoogle Scholar
  14. 14.
    Caudle AS, Yang WT, Mittendorf EA, et al. Selective surgical localization of axillary lymph nodes containing metastases in patients with breast cancer. a prospective feasibility trial. JAMA Surg. 2015;150(2):137–43.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Donker M, Straver ME, Wesseling J, et al. Marking axillary lymph nodes with radioactive iodine seeds for axillary staging after neoadjuvant systemic treatment in breast cancer patients: the MARI procedure. Ann Surg. 2015;261(2):378–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Choy N, Lipson J, Porter C, et al. Initial results with preoperative tattooing of biopsied axillary lymph nodes and correlation to sentinel lymph nodes in breast cancer patients. Ann Surg Oncol. 2015;22(2):377–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Dauphine C, Reicher JJ, Reicher MA, Gondusky C, Khalkhali I, Kim M. A prospective clinical study to evaluate the safety and performance of wireless localization of nonpalpable breast lesions using radiofrequency identification technology. AJR Am J Roentgenol. 2015:204(6),W720–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Douek M, Klasse J, Monypenny I, et al. Sentinel node biopsy using a magnetic tracer versus standard technique: the SentiMAG Multicentre Trial. Ann Surg Oncol. 2014;21(4):1237–45.CrossRefPubMedGoogle Scholar
  19. 19.
    Thill M, Kurkylcio A, Welter R, et al. The Central-European SentiMag Study: sentinel lymph node biopsy with superparamagnetic iron oxide (SPIO) vs. radioisotope. Breast. 2014;23(2):175–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Rubio IT, Diaz-Botero S, Esgueva A, et al. The superparamagnetic iron oxide is equivalent to the Tc99 radiotracer method for identifying the sentinel lymph node in breast cancer. Eur J Surg Oncol. 2015;41(1):46–51.CrossRefPubMedGoogle Scholar
  21. 21.
    Pinero-Madrona A, Torro-Richart JA, de Leon-Carrillo JM, et al. Superparamagnetic iron oxide as a tracer for sentinel node biopsy in breast cancer: a comparative non-inferiority study. Eur J Surg Oncol. 2015;41(8):991–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Ghilli M, Carretta E, Di Filippo F, et al. The superparamagnetic iron oxide tracer: a valid alternative in sentinel node biopsy for breast cancer treatment. Eur J Cancer Care (Engl). 2017. doi: 10.1111/ecc.12385.
  23. 23.
    Pinkney DM, Mychajlowycz M, Shah BA. A prospective comparative study to evaluate the displacement of four commercially available breast biopsy markers. Br J Radiol. 2016;89(1065):20160149.Google Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Toan T. Nguyen
    • 1
  • Tina J. Hieken
    • 1
  • Katie N. Glazebrook
    • 2
  • Judy C. Boughey
    • 1
    Email author
  1. 1.Department of SurgeryMayo ClinicRochesterUSA
  2. 2.Department of Diagnostic RadiologyMayo ClinicRochesterUSA

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