Combined procedure of marking axillary positive node with iodine-125 seed and sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy

• Published in: Revista Española de medicina nuclear e imagen molecular (English ed.) Vol. 39; no. 2; pp. 75 - 83
• Main Authors: Custodio Rebollo Aguirre, A, Sánchez Sánchez, R, González Jiménez, A D, Culiañez Casas, M, Mendoza Arnau, I, Rashki, M, Rudolphi Solero, T, Martínez Meca, S
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-03-2020
• Subjects: Adult; Aged; Axilla; Breast - pathology; Breast Neoplasms - chemistry; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Carcinoma, Ductal, Breast - chemistry; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - drug therapy; Carcinoma, Ductal, Breast - pathology; Female; Humans; Iodine Radioisotopes - administration & dosage; Lymph Node Excision; Middle Aged; Neoadjuvant Therapy; Positron Emission Tomography Computed Tomography; Prospective Studies; Sentinel Lymph Node - diagnostic imaging; Sentinel Lymph Node - pathology; Sentinel Lymph Node Biopsy - statistics & numerical data; Neoadjuvant chemotherapy; Quimioterapia neoadyuvante; Semilla radiactiva de yodo; Cáncer de mama; Ganglio positivo; Linfadenectomía axilar; Sentinel lymph node biopsy; Node-positive; Biopsia del ganglio centinela; Breast cancer; Axillary lymph node dissection; Radioactive iodine seed
• ISSN: 2253-8070; 2253-8089
• DOI: 10.1016/j.remn.2019.09.007

To present our initial experience in the combined procedure of intraoperative detection of axillary positive node marked with
I seed (ML) and sentinel node biopsy (SLN) after neoadjuvant chemotherapy (NACT), in breast cancer patients.
Prospective study, January 2017 - March 2019, 16 breast cancer patients T1-3N1. TNM stage: IIA: 3, IIB: 10, IIIA: 3. Histological type ductal invasive: 14. Molecular subtype: luminal A: 3, luminal B: 9, HER2: 3, basal like: 1. The ML was marked 227±36 days before neoadjuvant chemotherapy (n: 10), or 1-6 days before surgery, on previously identified node by ultrasound visibility marker, hydrogel (n: 3) or three dimensional-3D (n: 3). Axillary lymphadenectomy was undertaken in 10 patients.
ML and SLN were identified in the surgery in 93.7% (15/16) of the cases, in 33.3% (5/15) ML was not among SLN, and in only one patient (1/5) was there a discrepancy between the result of ML and SLN (macrometastases vs. negative 0/2). Median number of lymph nodes SLN: 2.2±0.9 (range 1-3) and AD: 13.5±5.2 (range 7-23). In all cases, histopathological analysis of ML,
I seed and/or marker within, correctly predicted axillary status after neoadjuvant chemotherapy. In all patients the
I radioactive seed was recovered.
Placing of
I seeds is a feasible technique for intraoperative location of axillary positive node combined with SLN. The histopathological result of ML allows the axillary status to be determined after neoadjuvant chemotherapy.