Trinh Long, Miyake Kanae K, Dirbas Frederick M, Kothary Nishita, Horst Kathleen C, Lipson Jafi A, Carpenter Catherine, Thompson Atalie C, Ikeda Debra M
Division of Breast Imaging, Department of Radiology, Stanford University School of Medicine, Stanford, California.
Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, California.
Breast J. 2016 Jul;22(4):390-6. doi: 10.1111/tbj.12597. Epub 2016 Apr 9.
Resection of biopsy-proven involved axillary lymph nodes (iALNs) is important to reduce the false-negative rates of sentinel lymph node (SLN) biopsy after neo-adjuvant chemotherapy (NAC) in patients with initially node-positive breast cancer. Preoperative wire localization for iALNs marked with clips placed during biopsy is a technique that may help the removal of iALNs after NAC. However, ultrasound (US)-guided localization is often difficult because the clips cannot always be reliably visible on US. Computed tomography (CT)-guided wire localization can be used; however, to date there have been no reports on CT-guided wire localization for iALNs. The aim of this study was to describe a series of patients who received CT-guided wire localization for iALN removal after NAC and to evaluate the feasibility of this technique. We retrospectively analyzed five women with initially node-positive breast cancer (age, 41-52 years) who were scheduled for SLN biopsy after NAC and received preoperative CT-guided wire localization for iALNs. CT visualized all the clips that were not identified on post-NAC US. The wire tip was deployed beyond or at the target, with the shortest distance between the wire and the index clip ranging from 0 to 2.5 mm. The total procedure time was 21-38 minutes with good patient tolerance and no complications. In four of five cases, CT wire localization aided in identification and resection of iALNs that were not identified with lymphatic mapping. Residual nodal disease was confirmed in two cases: both had residual disease in wire-localized lymph nodes in addition to SLNs. Although further studies with more cases are required, our results suggest that CT-guided wire localization for iALNs is a feasible technique that facilitates identification and removal of the iALNs as part of SLN biopsy after NAC in situations where US localization is unsuccessful.
切除经活检证实受累的腋窝淋巴结（iALNs）对于降低新辅助化疗（NAC）后初始淋巴结阳性乳腺癌患者前哨淋巴结（SLN）活检的假阴性率很重要。术前对活检时放置夹子标记的iALNs进行钢丝定位是一种可能有助于NAC后切除iALNs的技术。然而，超声（US）引导下的定位通常很困难，因为夹子在超声上不一定总能可靠地显示出来。计算机断层扫描（CT）引导下的钢丝定位可以使用；然而，迄今为止，尚无关于CT引导下iALNs钢丝定位的报道。本研究的目的是描述一系列在NAC后接受CT引导下钢丝定位以切除iALNs的患者，并评估该技术的可行性。我们回顾性分析了5例初始淋巴结阳性乳腺癌女性患者（年龄41 - 52岁），她们在NAC后计划进行SLN活检，并接受了术前CT引导下iALNs的钢丝定位。CT显示了所有在NAC后超声上未识别的夹子。钢丝尖端放置在目标之外或目标处，钢丝与索引夹子之间的最短距离为0至2.5毫米。总操作时间为21 - 38分钟，患者耐受性良好，无并发症。在5例中的4例中，CT钢丝定位有助于识别和切除淋巴绘图未识别的iALNs。2例证实有残留淋巴结疾病：除SLNs外，两者在钢丝定位的淋巴结中均有残留疾病。尽管需要更多病例的进一步研究，但我们的结果表明CT引导下iALNs钢丝定位是一种可行的技术，在超声定位不成功的情况下，作为NAC后SLN活检的一部分，有助于识别和切除iALNs。
