Targeted Axillary Dissection for Clinically Node-Positive Breast Cancer Cases that Turn Negative After Neoadjuvant...

Area of Science:

• Oncology
• Surgical Oncology
• Radiology

Background:

• Staging the axilla after neoadjuvant chemotherapy presents challenges, with sentinel node biopsy having high false negative rates.
• Accurate staging is crucial for treatment decisions in breast cancer patients.

Purpose of the Study:

• To evaluate the feasibility of axillary targeted surgery using lymph node charcoal tattooing for clinically positive nodes before neoadjuvant chemotherapy.
• To assess charcoal tattooing as a reliable method for identifying the primary axillary node for biopsy.

Main Methods:

• 30 breast cancer patients with suspicious axillary nodes underwent fine needle biopsy and carbon suspension injection.
• Patients with negative nodes post-chemotherapy had targeted excision of the tattooed and sentinel nodes.
• Axillary lymph node dissection was performed if positive nodes were found.

Main Results:

• Carbon tattooing successfully marked the lymph node in 93.3% of patients.
• The tattooed node was the sentinel node in 90.4% of cases undergoing targeted dissection.
• Targeted dissection identified positive nodes in 15/21 patients, necessitating further axillary dissection in 4.

Conclusions:

• Carbon tattooing is a safe, cheap, and reliable method for axillary lymph node localization after neoadjuvant chemotherapy.
• It serves as an excellent alternative to marker clips, particularly in low-resource settings, offering durable tissue staining without image guidance.