Feasibility of radioguided occult lesion localization of clip-marked lymph nodes for tailored axillary treatment in breast cancer patients treated with neoadjuvant systemic therapy

Background Selective removal of initially tumor-positive axillary lymph nodes in breast cancer patients who underwent neoadjuvant systemic treatment (NST) improves the accuracy of nodal staging and provides the opportunity for more tailored axillary treatment. This study evaluated whether radioguided occult lesion localization (ROLL) of clip-marked lymph nodes is feasible in clinical practice. Methods Prior to NST, a clip marker was placed inside a proven tumor-positive lymph node in all breast cancer patients (cTis-4N1-3 M0). After NST, technetium-99m-labeled macroaggregated albumin was injected in the clip-marked lymph nodes. The next day, these ROLL-marked nodes were selectively removed at surgery to evaluate the pathological response of the axilla. Results Thirty-seven patients (38 axillae) underwent clip insertion. After NST, the clip was visible by ultrasound in 36 procedures (95%). In the other two patients, the ROLL-node injection was performed in a sonographically suspicious unclipped node (1), and near the clip under computed tomography guidance (1). Initial surgery successfully identified the ROLL-marked node with clip in 33 procedures (87%). Removed specimens in the other five procedures contained only the sonographically suspicious tumor-positive unclipped node (1), a node with signs of complete response but no clip (2), a clip without node (1), and tissue without node nor clip, and a second successful ROLL-node procedure was performed (1). Overall, 10 ROLL-marked nodes had no residual disease. Conclusions This study demonstrates that the ROLL procedure to identify clip-marked lymph nodes is feasible. This facilitates selective removal at surgery and may tailor axillary treatment in patients treated with NST.

Procedimientos de mama guiados por resonancia magnética: nuestra experiencia

La resonancia magnética (RM) de seno es la modalidad diagnóstica más sensible para la detección de cáncer de seno; sin embargo, su especificidad es limitada, pues varía entre el 40 y 80 %. Esto se debe a las características de realce de algunas lesiones benignas que se sobreponen a las de lesiones malignas, y para cuyo diagnóstico se requiere análisis histológico. Para el diagnóstico histológico de estas lesiones —que solo se visualizan por RM y no por otro método diagnóstico— los procedimientos guiados por RM son la elección. La biopsia guiada por RM se utiliza en pacientes con ultrasonido dirigido negativo. El ROLL (Radioguided Occult Lesión Localization) es una técnica alternativa a la marcación prequirúrgica con alambre de lesiones ocultas y ha sido más ampliamente utilizada en ultrasonido que en RM, con muy buenos resultados. Se obtuvieron de manera retrospectiva los datos de las pacientes que ingresaron al sistema de nuestra institución para la realización de biopsia de seno y marcación de seno guiada por RM. Posteriormente se recopilaron las patologías. Los resultados se tabularon en Excel para su análisis.