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Published in: Annals of Surgical Oncology 8/2019

01-08-2019 | Breast Oncology

Pretreatment Tattoo Marking of Suspicious Axillary Lymph Nodes: Reliability and Correlation with Sentinel Lymph Node

Authors: Rupa Patel, MD, Wendy MacKerricher, MD, Jacqueline Tsai, MD, Nicole Choy, MD, Jafi Lipson, MD, Debra Ikeda, MD, Sunita Pal, MD, Wendy De Martini, MD, Kimberly H. Allison, MD, Irene L. Wapnir, MD

Published in: Annals of Surgical Oncology | Issue 8/2019

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Abstract

Background

Tattooing is an alternative method for marking biopsied axillary lymph nodes (ALNs) before initiation of treatments for newly diagnosed breast cancer. Detection of black ink-stained nodes is performed under direct visualization at surgery and is combined with sentinel node (SLN) mapping procedures.

Methods

Women with newly diagnosed breast cancer who underwent fine or core-needle biopsy of suspicious ALNs were recruited. The nodal cortex and perinodal soft tissue was injected with 0.1–1.0 ml of Spot™ (GI Supply) black ink under ultrasound guidance. Intraoperatively, black stained nodes were removed along with SLNs, noting concordance between the two.

Results

Sixty-six evaluable patients were enrolled (2013–2017). Nineteen received surgery first (Group 1) and 47 neoadjuvant therapy (NAT, Group 2). The average number of nodes tattooed was 1.16 for Group 1 and 1.04 for Group 2. The average interval from tattoo to surgery was 21 days (range 1–62) for Group 1 and 148 days (range 71–257) for Group 2. The tattooed node(s) were visually identified at surgery and corresponded to the sentinel lymph node(s) in 98.5% of cases (18/19 in Group 1 and 47/47 in Group 2). Of the 14 patients in Group 2 whose nodes remained positive following NAT, the tattooed node was the SLN associated with carcinoma.

Conclusions

Tattooing is an alternative method for marking biopsied ALNs. Tattooed nodes coincided with SLNs in 98.5% of cases. This technique is advantageous, because it allows for fewer procedures and lower costs compared with other methods.
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Metadata
Title
Pretreatment Tattoo Marking of Suspicious Axillary Lymph Nodes: Reliability and Correlation with Sentinel Lymph Node
Authors
Rupa Patel, MD
Wendy MacKerricher, MD
Jacqueline Tsai, MD
Nicole Choy, MD
Jafi Lipson, MD
Debra Ikeda, MD
Sunita Pal, MD
Wendy De Martini, MD
Kimberly H. Allison, MD
Irene L. Wapnir, MD
Publication date
01-08-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07419-3

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