Ultrasound-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy with clip and activated charcoal in breast cancer patients: a feasibility study
Won Hwa Kim,
Hye Jung Kim,
See Hyung Kim,
Jin Hyang Jung,
Ho Yong Park,
Jeeyeon Lee,
Wan Wook Kim,
Ji Young Park,
Yee Soo Chae,
Soo Jung Lee
Affiliations
Won Hwa Kim
Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
Hye Jung Kim
Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
See Hyung Kim
Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital
Jin Hyang Jung
Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
Ho Yong Park
Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
Jeeyeon Lee
Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
Wan Wook Kim
Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
Ji Young Park
Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
Yee Soo Chae
Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
Soo Jung Lee
Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital
Abstract Background We report on our experience of ultrasound (US)-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy (NAC) with clip and activated charcoal to guide axillary surgery in breast cancer patients. Methods Between November 2017 and May 2018, a dual-localization procedure was performed under US guidance for the most suspicious axillary nodes noted at initial staging (before NAC, with clip) and restaging (after NAC, with activated charcoal) in 28 cytologically proven node-positive breast cancer patients. Patients underwent axillary sampling or dissection, which involved removing not only the sentinel nodes (SNs), but also clipped nodes (CNs) and tattooed nodes (TNs). Success (or failure) rates of biopsies of SNs, CNs, and TNs and inter-nodal concordance rates were determined. Sensitivities for the individual and combined biopsies were calculated. Results SN biopsy failed in four patients (14%), whereas the CN biopsy failed in one patient (4%). All TNs were identified in the surgical field. Concordance rates were 79% for CNs–TNs, 63% for CNs–SNs, and 58% for TNs–SNs. Sensitivity for SN, CN, and TN biopsy was 73%, 67%, and 67%, respectively. Sensitivity was 80% for any combination of biopsies (SN plus CN, SN plus TN, SN plus CN plus TN). Conclusions US-guided dual-localization of axillary nodes before and after NAC with clip and activated charcoal was a feasible approach that might facilitate more reliable nodal staging with less-invasive strategies in node-positive breast cancer patients.
