The role of radioactive iodine-125 seed localization in breast-conserving therapy following neoadjuvant chemotherapy

Abstract Objective The objective of this retrospective study is to characterize challenges with ultrasound (US)-guided localization of clipped metastatic axillary lymph nodes after neoadjuvant chemotherapy. Methods After institutional review board approval, our radiology database was searched for all radioactive seed localizations (RSLs), which use a low-dose radioactive isotope, Iodine-125, performed for clipped axillary lymph nodes between January 1, 2016, and December 31, 2018. The details of each procedure were reviewed. RSL was defined to be successful if US-guidance was used, and postlocalization imaging showed the seed was no more than 1 cm away from the target. Cause and subsequent management of unsuccessful localizations were documented. Results During the study period, 139 clipped axillary lymph nodes (in 138 women and 1 man) were scheduled for preoperative RSL. The overall success rate of RSL was 106/139 (76%). The number of unsuccessful localizations was 10/37 (27%) in 2016, 7/39 (18%) in 2017, and 16/63 (25%) in 2018, with a total unsuccessful case frequency of 33/139 (24%) over the entire study period. The mean time interval between marker placement and localization was 6.0 months (range 0.4–18.1 months). The coil biopsy marker was the most frequently used marker. Conclusions Preoperative US-guided I-125 seed localization of clipped metastatic axillary lymph nodes is suboptimal or unsuccessful 24% of the time. Other options for non-US imaging-guided localizations, such as tomosynthesis, are available for consideration when US detection is unsuccessful.

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The Role of Endotoxaemia in the development of Renal Disorders Experimental Obstructive Jaundice in Rats

HPB Surgery ◽

10.1155/1996/85863 ◽

1996 ◽

Vol 10 (1) ◽

pp. 7-10 ◽

Cited By ~ 3

Author(s):

Janusz Dawiskiba

Keyword(s):

Single Dose ◽

Obstructive Jaundice ◽

Radioactive Iodine ◽

Endotoxic Shock ◽

Acute Circulatory Failure ◽

Isotope Study ◽

Increased Sensitivity ◽

Iodine 125 ◽

Kidney Liver

In rats with 2-week obstructive jaundice the sensitivity to endotoxin was studied and the effect of a single dose of endotoxin on histological development in the kidney, liver and spleen was also investigated. We were tested the effect on accumulation and distribution within organs, of fibrinogen labelled with radioactive iodine 125. We showed an increased sensitivity to endotoxin in obstructive jaundice. The cause of death in most rats was acute circulatory failure during the course of endotoxic shock, without clinical features of disseminated intravascular coagulation. In the isotope study, after endotoxin administration there was a specific dynamic increase of fibrinogen accumulation in the kidneys of rats with obstructive jaundice. We proposed, that the cause of the kidney changes during the course of obstructive jaundice could be the local activation of intrarenal coagulation.

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Radioactive iodine-125 seed localization as an aid in reoperative neck surgery

The American Journal of Surgery ◽

10.1016/j.amjsurg.2020.12.048 ◽

2021 ◽

Author(s):

Michael D. Bortz ◽

Amna Khokar ◽

David J. Winchester ◽

Tricia A. Moo-Young ◽

David B. Ecanow ◽

...

Keyword(s):

Radioactive Iodine ◽

Neck Surgery ◽

Seed Localization ◽

Iodine 125

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Novel surgical technique to selectively remove metastatic axillary lymph nodes in breast cancer patients after neoadjuvant chemotherapy: The MARI procedure—Marking of the axilla with radioactive iodine seeds.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.196 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 196-196

Author(s):

Marie-Jeanne TFD Vrancken Peeters ◽

Marieke Evelien Straver ◽

Mila Donker ◽

Claudette Loo ◽

Gabe S. Sonke ◽

...

Keyword(s):

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Axillary Lymph Node ◽

Radioactive Iodine ◽

Pathological Response ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Dissection ◽

Iodine 125

196 Background: An important benefit of neoadjuvant chemotherapy (NAC) is the increase in breast-conserving surgery. At present the response of axillary lymph node metastases to chemotherapy cannot be accurately assessed. Therefore axilla-conserving therapy is not yet a benefit. We aimed to assess a new surgical method to evaluate the axillary response: the MARI procedure, which stands for Marking of the Axillary lymph node with Radioactive Iodine seeds. Methods: Prior to NAC, proven tumor-positive axillary lymph nodes were marked with a Iodine-125 seed. After NAC, the marked lymph node was selectively removed with the use of a gamma-detection probe. A complementary axillary lymph node dissection was performed to assess whether pathological response in the marked node was indicative for the pathological response in the additional lymph nodes. Results: Tumor-positive axillary lymph nodes were successfully marked with Iodine-125 seeds in 68 patients. The marked lymph node (MARI-node) was surgically detected and selectively removed after NAC in all patients. The pathological response to chemotherapy in the MARI-node was indicative for the overall response in the additionally removed lymph nodes. In 47 patients the MARI-node contained residual disease (n=45 macrometastasis, n= 2 ITC). Thirty-five of them had macro- or micro metastases in the complementary axillary lymph node dissection specimen. In 21 patients the MARI-node was tumor negative. In 2 patients a macro metastasis was found in the additionally removed nodes, in 2 patients ITC were found and in the remaining 17 patients no residual tumor was found in the additionaly removed lymphnodes. (false negative rate of the MARI procedure: 9.5%). Conclusions: This study shows that marking and selectively removing metastatic lymph nodes after NAC is feasible. The tumor-response in the marked lymph node may be used to tailor further axillary treatment, and herewith enabling axilla-conserving surgery after neoadjuvant chemotherapy.

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