Lymph node tattooing for targeted axillary dissection in postneoadjuvant chemotherapy breast cancer

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Abstract

Introduction
Sentinel lymph node biopsy (SLNB) for patients with breast cancer with their axilla showing clinically node-positive disease (CN+ve) reduces morbidity and provides a higher quality of life by sparing axillary lymph node dissection for those patients whose axillary status changed from (CN+ve) to (CN0) after neoadjuvant chemotherapy. SLNB results are not encouraging in post-NACT setting; however, when it is combined with excision of previously marked positive LN, during targeted axillary dissection (TAD), identification rate (IR), and false-negative rate (FNR) are improved. The authors used suspended carbon particles (Blackeye ink) for preoperative LN marking, being a cheap alternative. Initial findings on TAD procedure following NACT on tattooed LNs and also the findings of SLNB by injecting 1% methylene blue (MB) were reported.
Patients and methods
A total of 40 patients with locally advanced breast cancer who were converted from cN+ to cN0 following NACT were divided into group A (20 patients), where TAD was performed and tattooed pathologically proven positive nodes besides SLNs were dissected, and group B (20 patients) for whom only SLNB using 1%MB was done. Backup axillary LN dissection was performed in all patients. The authors then compared IR and FNR in both groups.
Results
Blackeye ink was identified during surgery as a black stain on LNs. When the authors compared the results of TAD with SLNB, the authors found that diagnostic performance of TAD had the highest values, with FNR of 8.3% versus 15.3% in the SLNB group.
Conclusion
TAD using Blackeye ink and 1%MB has high IR and low FNR. It improves the accuracy of post-NACT axillary staging at very low cost.

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