Tan Mona P, Bi Zhen, Ong Eugene M W
Breast Surgical Oncology, MammoCare, Singapore, 38 Irrawaddy Road, #06-21, Singapore 329563, Republic of Singapore.
The Orchard Imaging Centre, Asiamedic Limited, Singapore, Republic of Singapore.
Clin Imaging. 2020 Dec;68:36-44. doi: 10.1016/j.clinimag.2020.06.009. Epub 2020 Jun 10.
A targeted surgical approach which accurately determines axillary status after neoadjuvant chemotherapy (NAC) may allow appropriate de-escalation of surgical treatment. It is postulated that the combined use of a particular marker clip, ULTRACOR®TWIRL™ (Bard, Inc.), and specific ultrasound settings for its identification, may overcome the challenges of pre-operative localisation with size diminution of nodes following NAC. Hence, this feasibility study was performed.
Three patients with locally advanced breast cancer (LABC), who had the Twirl marker clip placed in biopsy-proven metastatic axillary lymph nodes and completed treatment were included in this preliminary study. Preoperative sonographic identification of the clip and associated node was done on the day of surgery, confirmed by eliciting the 'twinkle' artifact, followed by hookwire localisation and resection. The 'twinkle' artifact was demonstrated within each specimen after resection.
All three patients who completed treatment for LABC had successful identification and resection of clipped node aided by the 'twinkle artifact'.
The 'twinkle' artifact is a novel and useful aid in identifying the Twirl™ clip marking a lymph node in the post-NAC setting, with the potential to be used intraoperatively.
一种能准确确定新辅助化疗（NAC）后腋窝状态的靶向手术方法，可能会使手术治疗适当降级。据推测，联合使用一种特殊的标记夹ULTRACOR®TWIRL™（巴德公司）及其识别所需的特定超声设置，可能会克服NAC后因淋巴结尺寸缩小导致的术前定位挑战。因此，开展了这项可行性研究。
本初步研究纳入了3例局部晚期乳腺癌（LABC）患者，这些患者在经活检证实的转移性腋窝淋巴结中放置了Twirl标记夹并完成了治疗。手术当天对夹子及相关淋巴结进行术前超声识别，通过引发“闪烁”伪像来确认，随后进行钩线定位和切除。切除后在每个标本中均显示出“闪烁”伪像。
所有3例完成LABC治疗的患者均借助“闪烁伪像”成功识别并切除了夹闭的淋巴结。
“闪烁”伪像是一种新颖且有用的辅助手段，可用于在NAC后的情况下识别标记淋巴结的Twirl™夹，具有术中使用的潜力。
