Intermediary clip placement to assist accurate axillary lymph node localization.

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Background:

• Image-guided localization of metastatic axillary lymph nodes is crucial for breast cancer treatment.
• National Comprehensive Cancer Network guidelines recommend clipping and removal of positive axillary lymph nodes before neoadjuvant therapy.
• Targeted axillary surgery after neoadjuvant chemotherapy (NAC) is increasingly supported, involving excision of clipped nodes.

Purpose of the Study:

• To describe a novel technique for improving the accuracy of localizing clipped axillary lymph nodes.
• To address challenges in identifying target lymph nodes that have decreased in size or are deep after NAC.
• To present case examples of successful localization using an intermediary clip method.

Main Methods:

• Placement of an intermediary clip in questionable target lymph nodes.
• Confirmation of intermediary clip co-localization with the intended target node using an axillary mammographic view.
• Subsequent safe and accurate localization of the confirmed target node.

Main Results:

• The intermediary clip technique facilitated accurate localization in all three described cases.
• This method confirmed the position of previously clipped axillary lymph nodes that were difficult to identify.
• Successful localization enabled precise surgical removal of target nodes.

Conclusions:

• The intermediary clip and mammographic confirmation method is valuable for accurate localization of challenging axillary lymph nodes.
• This technique enhances the safety and precision of targeted axillary surgery following NAC.
• It offers a reliable solution for identifying metastatic lymph nodes that have become difficult to visualize post-treatment.