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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Surgery, Stanford University School of Medicine and the Stanford Cancer Institute, Stanford, CA, USA

    Nicole Choy MD, Catherine Porter DO, Anne Kieryn MD, Amanda Wheeler MD, FACS & Irene Wapnir MD, FACS

  2. Department of Radiology, Stanford University School of Medicine and the Stanford Cancer Institute, Stanford, CA, USA

    Jafi Lipson MD, Sunita Pal MD, Jennifer Kao MD, Long Trinh MD & Debra Ikeda MD, FACR

  3. Department of Pathology, Stanford University School of Medicine and the Stanford Cancer Institute, Stanford, CA, USA

    Michael Ozawa MD, Kristin Jensen MD & Kimberly Allison MD

Authors
  1. Nicole Choy MD
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  2. Jafi Lipson MD
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  3. Catherine Porter DO
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  4. Michael Ozawa MD
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  5. Anne Kieryn MD
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  6. Sunita Pal MD
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  7. Jennifer Kao MD
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  8. Long Trinh MD
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  9. Amanda Wheeler MD, FACS
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  10. Debra Ikeda MD, FACR
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  13. Irene Wapnir MD, FACS
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Correspondence to Irene Wapnir MD, FACS.

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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 22, 377–382 (2015). https://doi.org/10.1245/s10434-014-4034-6

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  • DOI: https://doi.org/10.1245/s10434-014-4034-6

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