Lymph node tattooing for targeted axillary dissection in postneoadjuvant chemotherapy breast cancer | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 41, Issue 4, April 2023 PDF (1.9 MB) | ||||
| DOI: 10.4103/ejs.ejs_299_22 | ||||
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| Authors | ||||
| Emad Khallaf; Somia Abdelatif; Rasha Wessam; Mohamed Abdoon; Mohamed Zaazou | ||||
| Abstract | ||||
| Introduction Sentinel lymph node biopsy (SLNB) for patients with breast cancer with their axilla showing clinically node-positive disease (CN+ve) reduces morbidity and provides a higher quality of life by sparing axillary lymph node dissection for those patients whose axillary status changed from (CN+ve) to (CN0) after neoadjuvant chemotherapy. SLNB results are not encouraging in post-NACT setting; however, when it is combined with excision of previously marked positive LN, during targeted axillary dissection (TAD), identification rate (IR), and false-negative rate (FNR) are improved. The authors used suspended carbon particles (Blackeye ink) for preoperative LN marking, being a cheap alternative. Initial findings on TAD procedure following NACT on tattooed LNs and also the findings of SLNB by injecting 1% methylene blue (MB) were reported. Patients and methods A total of 40 patients with locally advanced breast cancer who were converted from cN+ to cN0 following NACT were divided into group A (20 patients), where TAD was performed and tattooed pathologically proven positive nodes besides SLNs were dissected, and group B (20 patients) for whom only SLNB using 1%MB was done. Backup axillary LN dissection was performed in all patients. The authors then compared IR and FNR in both groups. Results Blackeye ink was identified during surgery as a black stain on LNs. When the authors compared the results of TAD with SLNB, the authors found that diagnostic performance of TAD had the highest values, with FNR of 8.3% versus 15.3% in the SLNB group. Conclusion TAD using Blackeye ink and 1%MB has high IR and low FNR. It improves the accuracy of post-NACT axillary staging at very low cost. | ||||
| Keywords | ||||
| breast cancer; methylene blue; sentinel lymph node biopsy; targeted axillary dissection | ||||
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