scholarly journals Pre-Operative Localization of Axillary Lymph Nodes with Tattoo Ink: A Preliminary Report

2021 ◽  
pp. 143-148
Author(s):  
Kelly S Myers ◽  
Sachin Aggarwal ◽  
Eniola T Oluyemi ◽  
Mehran Habibi ◽  
Emily B Ambinder ◽  
...  

Background: Pre-operative localization options in the axilla are limited. This study aimed to explore the utility of pre-operative localization of axillary lymph nodes using tattoo ink with multidisciplinary correlations.Methods: In this prospective, Institutional Review Board (IRB)-approved study, 19 lymph nodes in 17 patients underwent pre-operative localization with ultrasound-guided injection of Spot tattoo ink. The success rate of intraoperative identification of the tattooed node as well as the frequency in which the tattooed node was also a sentinel node were recorded. Radiologic, surgical and pathologic images were collected. Results: Tattoo ink localization was successful in 16/17 (94.1%) of patients. Tattoo ink did not hinder pathologic evaluation in any cases but was taken up by additional adjacent nodes in 1/17 successful localizations (5.9%). Successful sentinel lymph node biopsy (SLNB) occurred in 13 patients in whom 14 lymph nodes underwent pre-operative tattoo ink localization. Nine of the 14 (64.2%) tattooed lymph nodes were also a sentinel node.Conclusion: In this study, pre-operative localization of axillary lymph nodes with tattoo ink was highly successful In patients undergoing SLNB, a significant number of the tattooed nodes were not sentinel nodes (35.8%), suggesting the importance of targeted lymph node excision in addition to SLNB.

Author(s):  
Ankur Garg ◽  
Udbhav Kathpalia ◽  
Shweta Bansal ◽  
Manoj Andley ◽  
Sudipta Saha

Background : Locally advanced breast carcinoma (LABC) includes a wide range of clinical scenarios- advanced primary tumors (T4), advanced nodal disease and inflammatory carcinomas(1). Traditionally, treatment of LABC included a combination of Chemotherapy, Radiation and Surgery(2). However, there has been a shift to Neoadjuvant Chemotherapy in recent times.(3) Histological status and the number of axillary lymph nodes with metastasis is one of the most important prognostic factors and most powerful predictor of recurrence and survival in patients of breast carcinoma and remains so, even after neo-adjuvant chemotherapy. (3) Information derived from the sentinel lymph node is considered valuable, with less discomfort to the patient when compared with axillary dissection.(4) However, its role in detecting nodal metastasis after neo-adjuvant chemotherapy in LABC is still debatable and definitive studies to evaluate its role are still evolving. (5) Materials and Methods: Patients of LABC were evaluated using ultrasonography (USG) of axilla. Neo-adjuvant chemotherapy (NACT) was administered and patients were reassessed by USG of axilla. Thirty patients with node negative axillary status were subjected to Sentinel lymph node mapping using isosulfan blue followed by Modified Radical Mastectomy and Axillary Lymph Node Dissection. Histopathological evaluation of stained and unstained lymph nodes done and the data, thus obtained, was statistically analysed.   Results: Sentinel lymph node biopsy performed using Isosulfan Blue dye alone, after neo-adjuvant chemotherapy predicts the status of axillary lymph nodes with low accuracy.   Conclusions: Further studies would be required to establish the role of sentinel lymph node biopsy in patients with LABC after NACT.


2021 ◽  
Vol 3 (5) ◽  
pp. 583-590
Author(s):  
Marlen Pajcini ◽  
Irene Wapnir ◽  
Jacqueline Tsai ◽  
Joanne Edquilang ◽  
Wendy DeMartini ◽  
...  

Abstract Objective To describe tattoo ink marking of axillary lymph nodes (TIMAN) and the elements leading to successful removal at sentinel lymph node biopsy (SLNB). Methods An IRB-approved retrospective image review was conducted of breast cancer patients who underwent SLNB after TIMAN from February 2013 to August 2017, noting patient and tattooed lymph node (TLN) features, initial biopsy type, time to surgery, if the TLN was identified at surgery, and correlation with the SLN. Cases were divided into two groups: the presurgical group, which had primary surgery, and the pre-neoadjuvant chemotherapy (NACT) group, which underwent surgery after completing NACT. Results Of 30 patients who underwent 32 TIMAN procedures, 10 (33.3%) were presurgical and 20 (66.7%) were pre-NACT. The average lymph node (LN) depth from the skin was 1.6 cm, with an average of 0.3 mL of tattoo ink injected. Of 32 procedures, 29 (90.6%) had US images demonstrating the injection. Of these, 10 (34.5%) were injected in the LN cortex surface and 19 (65.5%) in the middle cortex. Seven (24.1%) were injected in the LN lateral aspect, 12 (41.4%) in the mid aspect, and 10 (34.5%) in the medial aspect. Of 32 LNs, 28 (87.5%) were tattooed immediately after initial biopsy and 4 (12.5%) at a later date. At SLNB, all 32 (100%) TLNs were identified, all correlated with the SLN, and 10 (31.3%) were positive for cancer. Conclusion Using an average of 0.3 mL of tattoo ink, all TLNs were successfully identified for removal at surgery, despite variability in LN and injection factors.


2001 ◽  
Vol 182 (4) ◽  
pp. 316-320 ◽  
Author(s):  
Shahab F Abdessalam ◽  
Emmanuel E Zervos ◽  
Manju Prasad ◽  
William B Farrar ◽  
Lisa D Yee ◽  
...  

2021 ◽  
Vol 100 (6) ◽  

Introduction: The role of sentinel lymph node biopsy (SLNB) in patients with breast cancer after neoadjuvant chemotherapy (NAC) is currently under discussion. The aim of our study was to determine the false negativity rate (FNR) of SLNB, the accuracy of ultrasound examination in the evaluation of the status of lymph nodes and the accuracy of perioperative cryobiopsy of the sentinel lymph node (SLN). Methods: Prospective multicentre study, which took place in years 2018−2020 at three centres in the Czech Republic. A total of 59 patients were evaluated. Results: The FNR of SLNB in the group of patients with cN1 before NAC and ycN0 after NAC was 12.5%. The FNR of perioperative histological examination of the SLN was 38.5%. The FNR of ultrasound examination of axillary lymph nodes in patients after NAC was 35.5%, and the false positivity rate was 16.7%. The incidence of inflammatory complications in our cohort was 3.3%. Conclusion: The FNR of SLNB in the group of patients with cN1 before NAC and ycN0 after NAC exceeds the tolerable limit of 10%. The FNR of perioperative histological examination of the SLN is high; definitive histological examination of the SLN may change the original diagnostic-therapeutic plan. Ultrasound examination of the axillary lymph nodes in patients after NAC is a method with high false negativity and positivity and may not correspond with the perioperative finding. The incidence of inflammatory complications in our cohort in patients after NAC is comparable to literature data on the frequency of complications in patients without NAC.


2015 ◽  
Vol 13 (3) ◽  
pp. 423-425 ◽  
Author(s):  
Silvio Eduardo Bromberg ◽  
Paulo Gustavo Tenório do Amaral

Coexistence of breast cancer and tuberculosis is rare. In most cases, involvement by tuberculosis occurs in axillary lymph nodes. We report a case of a 43-years-old patient who had undergone adenomastectomy and left sentinel lymph node biopsy due to a triple negative ductal carcinoma. At the end of adjuvant treatment, the patient had an atypical lymph node in the left axilla. Lymph node was excised, and after laboratory analysis, the diagnosis was ganglion tuberculosis. The patient underwent treatment for primary tuberculosis. The development of these two pathologies can lead to problems in diagnosis and treatment. An accurate diagnosis is important to avoid unnecessary surgical procedures.


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