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

Staging of positive axilla that showed negativity after neo-adjuvant chemotherapy is a subject of controversy. In this situation, sentinel node biopsy is debatable due to high false negative rates. This study evaluates the feasibility of axillary targeted surgery after lymph node charcoal tattooing for clinically positive nodes prior to neo-adjuvant chemotherapy. This study included 30 cases of breast cancer with clinically suspicious axillary nodes who were planned for neo-adjuvant chemotherapy. They underwent fine needle biopsy from the suspicious node with simultaneous injection of carbon suspension. After therapy, those who showed negativity on repeat ultrasound had exploration with excision of the tattooed and the sentinel node. Axillary lymph node dissection was performed if any of both was pathologically involved. A total of 30 patients were carbon-labelled before systemic therapy. Twenty-one were included in the final analysis, while 9 patients were excluded. Carbon-tattooed lymph node was in 28/30 patients (93.3%). In patients who had targeted dissection, the charcoaled and sentinel nodes were the same in 19/21 patients (90.4%), and in this group, 15/21 patients had positive targeted dissection, and we proceeded to axillary dissection in 4 patients who showed positive nodes. Targeted LN was not the sentinel node in two patients; in both, all nodes were negative. Carbon tattooing of axillary lymph nodes provides a safe, cheap, and reliable alternative to marker clips without the need for image guidance to locate the marked node which provides an excellent alternative in low-resource countries with the advantage of durable tissue staining.