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Lost clips after targeted lymph node biopsy in breast cancer patients: Follow-up of the CLIP-study
Steffi Hartmann1, Angrit Stachs1, Bernd Gerber1
1Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany.
Introduction:
Clipping and selective removal of axillary lymph nodes in breast cancer patients presenting with initially node-positive disease and achieving a nodal downstaging after primary systemic therapy is a less invasive method for axillary staging. An imaging guided localization and successful extirpation of these clipped lymph nodes is not possible in all patients. To date no follow-up data regarding patients with lost clips are available.
Material And Methods:
The oncological outcome of all participants of the CLIP-study and the results of postoperative axillary imaging in those patients with unproven clip resection are presented.
Results:
A total of thirty patients were included into the pilot study. In ten of these patients (33%) the removal of the clipped axillary lymph node could not be verified by intraoperative radiograph. Postoperative imaging did not find lost clips in eight of these ten patients (80%). The lost clip was detected in two patients after surgery (20%), by mammography in one patient during routine follow-up and by computed tomography scan in one patient before radiotherapy. After a median follow-up of 40 months, 26 (87%) patients were still alive. Seven patients (23%) developed distant recurrent disease. No local or axillary recurrences were observed.
Conclusion:
Lost clips were detected by postoperative imaging only in a minority of patients. The impact of lost clips on axillary recurrences in breast cancer patients is still unclear and should be further clarified in larger, multicentric trials.
Insights
In breast cancer patients, clipped lymph node removal after therapy can be challenging. Lost clips were rarely found post-surgery, and their impact on axillary recurrence needs further study.
Area of Science:
- Oncology
- Surgical Oncology
- Radiology
Background:
- Selective axillary lymph node removal after neoadjuvant therapy is a less invasive staging method for node-positive breast cancer.
- Clip-based localization of lymph nodes for removal is not always successful.
- No prior follow-up data exists for patients with unresected clipped lymph nodes.
Purpose of the Study:
- To evaluate the oncological outcomes of breast cancer patients in the CLIP-study.
- To assess the results of postoperative axillary imaging in patients with unproven clip resection.
Main Methods:
- A pilot study included thirty breast cancer patients.
- Intraoperative radiography was used to verify clip removal.
- Postoperative imaging (mammography, CT) was employed to locate lost clips.
Main Results:
- Clip removal was unverified in 10% of patients (33%).
- Postoperative imaging identified lost clips in only 20% of these cases.
- After a median follow-up of 40 months, no local or axillary recurrences were observed, though 23% developed distant recurrence.
Conclusions:
- Postoperative imaging infrequently detects lost clips.
- The effect of lost clips on axillary recurrence in breast cancer requires further investigation in larger trials.
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