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Enhanced Axillary Evaluation Using Reflector-Guided Sentinel Lymph Node Biopsy: A Prospective Feasibility Study and
Bret Taback1, Priya Jadeja1, Richard Ha2
1Department of Breast Surgery, Columbia University Medical Center, New York, NY.
Reflector-guided excision of percutaneously biopsied nodes improves sentinel lymph node biopsy accuracy after neoadjuvant chemotherapy, enhancing axillary status assessment and minimizing surgical intervention risks.
Area of Science:
- Oncology
- Surgical Oncology
- Radiology
Background:
- Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) aims to reduce axillary surgery.
- Higher false negative rates in SLNB post-NAC can lead to inaccurate prognosis and residual disease.
- Accurate axillary staging is crucial for treatment response assessment.
Purpose of the Study:
- To evaluate the efficacy of reflector-guided excision of percutaneously biopsied nodes (PBN) as an aid to conventional SLNB.
- To assess the PBN as a predictor of axillary status following NAC.
- To improve the accuracy of SLNB in the post-NAC setting.
Main Methods:
- Single-institution analysis comparing reflector-guided SLNB with conventional SLNB.
- Axillary fiducial-reflector placement followed by SLNB.
- Matched cohort analysis of 19 patients in the reflector group and 19 in the conventional group.
Main Results:
- Percutaneously biopsied node (PBN) identification in SLNB was 100% in the reflector group vs. 47.3% in the conventional group (P=.002).
- Overall PBN identification failure was 34.2% with traditional mapping.
- Negative PBN correctly reflected axillary status in 100% of cases, with no additional positive nodes found.
Conclusions:
- Reflector-guided excision of PBN is a facile and feasible method.
- This technique significantly improves the identification of the PBN compared to conventional SLNB post-NAC.
- Reflector-guided PBN excision accurately reflects axillary status after NAC, potentially improving patient management.
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