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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2018

01-03-2018 | Breast Oncology

Intraoperative Ultrasound-Guided Excision of Axillary Clip in Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Therapy (ILINA Trial)

A New Tool to Guide the Excision of the Clipped Node After Neoadjuvant Treatment

Authors: Christian Siso, MD, Juan de Torres, MD, Antonio Esgueva-Colmenarejo, MD, Martin Espinosa-Bravo, MD, Neus Rus, MD, Octavi Cordoba, MD, Roberto Rodriguez, MD, Vicente Peg, MD, Isabel T. Rubio, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2018

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Abstract

Background

The accuracy of sentinel lymph node biopsy (SLNB) after neoadjuvant therapy (NAT) has been improved with the placement of a clip in the positive node prior to treatment. Several methods have been described for clipped node excision during SLNB after NAT. We assessed the feasibility of intraoperative ultrasound (IOUS)-guided excision of the clipped node during SLNB and investigated whether the accuracy of SLNB is improved.

Methods

After approval by the Institutional Ethics Committee, all breast cancer patients undergoing NAT had an US-visible clip placed in the positive node. The ILINA trial consisted of IOUS-guided excision of the clipped node along with SLNB and axillary lymph node dissection (ALND).

Results

Forty-six patients had a clip placed in the positive node. In two (4.3%) cases, the clip could not be seen prior to surgery and the patient underwent ALND; however, the clipped node was successfully removed by IOUS-guided excision in 44 patients. Thirty-five patients (79.5%) underwent SLNB along with IOUS-guided excision of the clipped node and ALND, and were subsequently included in the ILINA trial. Nine patients were not included (five patients with SLNB only and four patients with ALND without SLNB). SLNB matched the clipped node in 27 (77%) patients. The false negative rate for the ILINA protocol was 4.1% (95% confidence interval 0.1–21.1%).

Conclusions

IOUS-guided excision of the axillary clipped node after NAT was feasible, safe, and successful in 100% of cases. The ILINA trial is accurate in predicting axillary nodal status after NAT.
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Metadata
Title
Intraoperative Ultrasound-Guided Excision of Axillary Clip in Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Therapy (ILINA Trial)
A New Tool to Guide the Excision of the Clipped Node After Neoadjuvant Treatment
Authors
Christian Siso, MD
Juan de Torres, MD
Antonio Esgueva-Colmenarejo, MD
Martin Espinosa-Bravo, MD
Neus Rus, MD
Octavi Cordoba, MD
Roberto Rodriguez, MD
Vicente Peg, MD
Isabel T. Rubio, MD, PhD
Publication date
01-03-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6270-z

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