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- W4309486528 abstract "Background: Targeted axillary dissection (TAD) after neoadjuvant chemotherapy (NAC) for breast cancer has proven safety and led to de-escalation of axillary surgery with low false negative rates (FNR). When the sentinel lymph node (SLN) is not the clipped node, retrieval of the clip might be challenging. Single Photon Emission Computed Tomography with integrated CT (SPECT/CT) is used for SLN identification in various diseases, providing information about the anatomical location of SLNs. In this study we aimed to show whether SPECT/CT could guide TAD by localizing where the SLN and clipped nodes are, and its reliability assisting surgery. Patients and methods: We reviewed the medical records of locally advanced breast cancer patients, diagnosed between September 2017 and June 2022. Sixty-two female breast cancer patients had biopsy-confirmed axillary nodal metastases and had NAC followed by breast surgery with TAD. Each patient had a metallic clip placed in the sampled lymph node prior to NAC. After completion of treatment the patients had breast surgery and sentinel lymph node biopsy (SLNB) with or without axillary lymph node dissection (ALND). All of the patients had SPECT/CT lymphoscintigraphy on the day of surgery. Periareolar 99mTechnetium-nanocolloid intradermal injection followed by dynamic, planar and SPECT/CT images were taken. The images were interpreted in workstation by the nuclear medicine specialist to assist the surgeon. We localized the sentinel node and the clips on CT images, before surgery. Depending on the surgeons choice blue dye (isosulphane-blue) was also administered. Removal of the clip was confirmed by specimen radiographs or macroscopic evaluation on table. Results: Sixty-two patients with T1-4, N1-2 breast cancers were enrolled in this study. The median age was 46.5 (25–74). The mean number of SLNs were 2.5 (range 1–6). Thirty-four (55.7%) patients had confirmed metastases intraoperatively and had further ALND; whereas 27 (44.3%) had SLNB only. SPECT/CT identified 1–5 (mean 1,8) SLNs in each patient. In 54 (88.5%) patients clipped node was the SLN. In 3 (4.9%) patients the clip was found in the nonSLN. In the remaining 4 patients the clips were neither localized by SPECT/CT nor during surgery. In all of the patients (100%) SPECT/CT correctly localized the clipped lymph node (Table 1). Overall the false negative rate of TAD was 3.33%. There is no axillary relapse seen in follow up of median 25 months (2–59months).Table 1:SPECT/CT (n)SURGERY (n)Clips in the SLNs5454Clips in the non-SLNs33Clips not identified44Accuracy100% Open table in a new tab Conclusion: SPECT-CT lymphoscintigraphy accurately localizes the SLN and the clips in the axilla, which can be reliably used to guide TAD in breast cancer surgery after NAC. No conflict of interest." @default.
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- W4309486528 date "2022-11-01" @default.
- W4309486528 modified "2023-09-28" @default.
- W4309486528 title "SPECT/CT lymphoscintigraphy can accurately localize the sentinel lymph nodes and the clipped node in breast cancer patients undergoing targeted axillary dissection after neoadjuvant chemotherapy" @default.
- W4309486528 doi "https://doi.org/10.1016/s0959-8049(22)01389-2" @default.
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