Advertisement

Ultrasound-guided radar reflector localization of axillary lymph nodes facilitates targeted axillary dissection

      Highlights

      • US-guided SAVI SCOUT® radar reflector localization of axillary lymph nodes is highly successful (97% initial placement success rate, 100% surgery retrieval success rate)
      • This facilitates targeted axillary dissection + sentinel lymph node biopsy in patients with high likelihood of achieving low nodal burden
      • For ER/PR+ patients with only 1 suspicious lymph node on initial imaging, 95% had low nodal burden after neoadjuvant chemotherapy
      Precis
      • US-guided SAVI SCOUT® radar reflector localization of axillary lymph nodes is highly successful and facilitates targeted axillary dissection in patients with a likelihood of low axillary nodal burden

      Abstract

      Purpose

      This study evaluated feasibility and patient outcomes for targeted axillary lymph node (LN) dissection (TAD) with SAVI SCOUT® ultrasound-guided radar reflector localization (RRL).

      Methods

      In this IRB-approved retrospective study, 800 consecutive patients who underwent ultrasound-guided RRL between November 2017 and June 2020 were reviewed. Of these patients, those with axillary LN RRL were included in this study. Reports in the electronic medical record were reviewed to determine RRL placement, retrieval, and surgical outcomes.

      Results

      A total of 147 patients met inclusion criteria. Of these, axillary RRL was performed for biopsy-proven metastatic disease in 134 and inconclusive or benign biopsy in 13. RRL was successful in 146/151 lymph nodes (97%). Two patients had placement >10 mm from target and 3 had no post-placement signal. In all 5, the targets were successfully retrieved at surgery. Specimen radiographs were performed in 135 cases and confirmed the intended target in all 135 (100%). In 109 patients who underwent TAD + sentinel lymph node biopsy (SLNB), the RRL LN and the SLN(s) were different in 18 (17%). In 3 of these, the RRL LN was the only malignant LN (3%). In the 105 patients who underwent neoadjuvant chemotherapy, 43% (45/105) achieved nodal pCR and 85% (89/105) had <3 metastatic lymph nodes at surgery.

      Conclusion

      Ultrasound-guided RRL of axillary LNs is a feasible approach to facilitate TAD with high placement and retrieval success rates. This enables TAD as an alternative to complete axillary LN dissection (cALND), sparing some patients with low nodal tumor burden from cALND.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brackstone M.
        • Baldassarre F.G.
        • Perera F.E.
        • et al.
        Management of the axilla in early-stage breast cancer: Ontario health (Cancer Care Ontario) and ASCO guideline.
        J Clin Oncol. 2021; 39: 3056-3082https://doi.org/10.1200/JCO.21.00934
        • Noguchi M.
        • Inokuchi M.
        • Noguchi M.
        • Morioka E.
        • Ohno Y.
        • Kurita T.
        Axillary surgery for breast cancer: past, present, and future.
        Breast Cancer. Jan 2021; 28: 9-15https://doi.org/10.1007/s12282-020-01120-0
        • Giuliano A.E.
        • Hunt K.K.
        • Ballman K.V.
        • et al.
        Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial.
        JAMA. 2011; 305: 569-575https://doi.org/10.1001/jama.2011.90
        • Sun J.
        • Henry D.A.
        • Carr M.J.
        • et al.
        Feasibility of axillary lymph node localization and excision using radar reflector localization.
        Clin Breast Cancer. 2020; (Aug 6)https://doi.org/10.1016/j.clbc.2020.08.001
        • Boughey J.C.
        • Suman V.J.
        • Mittendorf E.A.
        • et al.
        Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial.
        JAMA. 2013; 310: 1455-1461https://doi.org/10.1001/jama.2013.278932
        • Mamtani A.
        • Barrio A.V.
        • King T.A.
        • et al.
        How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study.
        Ann Surg Oncol. Oct 2016; 23: 3467-3474https://doi.org/10.1245/s10434-016-5246-8
        • Montagna G.
        • Mamtani A.
        • Knezevic A.
        • Brogi E.
        • Barrio A.V.
        • Morrow M.
        Selecting node-positive patients for axillary downstaging with neoadjuvant chemotherapy.
        Ann Surg Oncol. Oct 2020; 27: 4515-4522https://doi.org/10.1245/s10434-020-08650-z
        • Boughey J.C.
        • Ballman K.V.
        • Le-Petross H.T.
        • et al.
        Identification and resection of clipped node decreases the false-negative rate of sentinel lymph node surgery in patients presenting with node-positive breast cancer (T0–T4, N1–N2) who receive neoadjuvant chemotherapy: results from ACOSOG Z1071 (Alliance).
        Ann Surg. Apr 2016; 263: 802-807https://doi.org/10.1097/SLA.0000000000001375
        • Caudle A.S.
        • Yang W.T.
        • Krishnamurthy S.
        • et al.
        Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection.
        J Clin Oncol. 2016; 34: 1072-1078https://doi.org/10.1200/JCO.2015.64.0094
        • Kanesalingam K.
        • Sriram N.
        • Heilat G.
        • et al.
        Targeted axillary dissection after neoadjuvant systemic therapy in patients with node-positive breast cancer.
        ANZ J Surg. Mar 2020; 90: 332-338https://doi.org/10.1111/ans.15604
        • Falcon S.
        • Weinfurtner R.J.
        • Mooney B.
        • Niell B.L.
        SAVI SCOUT(R) localization of breast lesions as a practical alternative to wires: outcomes and suggestions for trouble-shooting.
        Clin Imaging. 2018; 52: 280-286https://doi.org/10.1016/j.clinimag.2018.07.008
        • Laws A.
        • Dillon K.
        • Kelly B.N.
        • et al.
        Node-positive patients treated with neoadjuvant chemotherapy can be spared axillary lymph node dissection with wireless non-radioactive localizers.
        Ann Surg Oncol. Nov 2020; 27: 4819-4827https://doi.org/10.1245/s10434-020-08902-y
        • Baker J.L.
        • Haji F.
        • Kusske A.M.
        • et al.
        SAVI SCOUT(R) localization of metastatic axillary lymph node prior to neoadjuvant chemotherapy for targeted axillary dissection: a pilot study.
        Breast Cancer Res Treat. Jan 2022; 191: 107-114https://doi.org/10.1007/s10549-021-06416-z
        • Nguyen T.T.
        • Hieken T.J.
        • Glazebrook K.N.
        • Boughey J.C.
        Localizing the clipped node in patients with node-positive breast cancer treated with neoadjuvant chemotherapy: early learning experience and challenges.
        Ann Surg Oncol. Oct 2017; 24: 3011-3016https://doi.org/10.1245/s10434-017-6023-z
        • Cortina C.S.
        • Gottschalk N.
        • Kulkarni S.A.
        • Karst I.
        Is breast magnetic resonance imaging an accurate predictor of nodal status after neoadjuvant chemotherapy?.
        J Surg Res. Jan 2021; 257: 412-418https://doi.org/10.1016/j.jss.2020.07.025
        • Wang X.
        • Chen L.
        • Sun Y.
        • Zhang B.
        Evaluation of axillary lymph node metastasis burden by preoperative ultrasound in early-stage breast cancer with needle biopsy-proven metastasis.
        Clin Transl Oncol. Apr 2020; 22: 468-473https://doi.org/10.1007/s12094-019-02162-3
        • Lim G.H.
        • Upadhyaya V.S.
        • Acosta H.A.
        • Lim J.M.A.
        • Allen Jr., J.C.
        • Leong L.C.H.
        Preoperative predictors of high and low axillary nodal burden in Z0011 eligible breast cancer patients with a positive lymph node needle biopsy result.
        Eur J Surg Oncol. Jul 2018; 44: 945-950https://doi.org/10.1016/j.ejso.2018.04.003
        • Pilewskie M.
        • Mautner S.K.
        • Stempel M.
        • Eaton A.
        • Morrow M.
        Does a positive axillary lymph node needle biopsy result predict the need for an axillary lymph node dissection in clinically node-negative breast cancer patients in the ACOSOG Z0011 era?.
        Ann Surg Oncol. Apr 2016; 23: 1123-1128https://doi.org/10.1245/s10434-015-4944-y
        • Kim R.
        • Chang J.M.
        • Lee H.B.
        • et al.
        Predicting axillary response to neoadjuvant chemotherapy: breast MRI and US in patients with node-positive breast cancer.
        Radiology. Oct 2019; 293: 49-57https://doi.org/10.1148/radiol.2019190014
        • Kim W.H.
        • Kim H.J.
        • Park H.Y.
        • et al.
        Axillary pathologic complete response to neoadjuvant chemotherapy in clinically node-positive breast cancer patients: a predictive model integrating the imaging characteristics of ultrasound restaging with known clinicopathologic characteristics.
        Ultrasound Med Biol. Mar 2019; 45: 702-709https://doi.org/10.1016/j.ultrasmedbio.2018.10.026
        • Turan U.
        • Aygun M.
        • Duman B.B.
        • et al.
        Efficacy of US, MRI, and F-18 FDG-PET/CT for detecting axillary lymph node metastasis after neoadjuvant chemotherapy in breast cancer patients.
        Diagnostics (Basel). 2021; 11 (Dec 14)https://doi.org/10.3390/diagnostics11122361