Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany.
Department of Obstetrics and Gynaecology, Klinikum Esslingen, Esslingen, Germany.
Br J Surg. 2021 Apr 5;108(3):302-307. doi: 10.1093/bjs/znaa083.
Several techniques for targeted lymph node biopsy in patients with node-positive breast cancer receiving primary systemic therapy are in use, each with their inherent advantages and disadvantages. The aim of the TATTOO trial was to evaluate the feasibility and accuracy of carbon tattooing of positive lymph nodes as a method for targeted lymph node biopsy avoiding radiation exposure, high costs, and preoperative localization procedures.
Patients with initially cT1-4c cN1-3 cM0 invasive breast cancer were included in this prospective multicentre trial. Before initiation of primary systemic therapy, a carbon suspension was injected into the most suspicious axillary lymph node. Targeted lymph node biopsy was performed in all patients after completion of primary systemic therapy. Additional sentinel lymph node biopsy was done in those with axillary downstaging, and completion axillary lymph node dissection in patients still presenting with suspicious lymph nodes.
A total of 118 patients were included and 110 were eligible for data analysis. The detection rate for the targeted lymph node was 93.6 per cent (103 of 110), and the sentinel lymph node was identical to the targeted lymph node in 60 per cent. The false-negative rate for the combination of targeted and sentinel node lymph node biopsy (targeted axillary dissection) was 9 per cent.
Targeted axillary dissection after carbon tattooing is associated with a high detection rate, an acceptable false-negative rate, and appears feasible for clinical use even in healthcare settings with limited resources.
在接受新辅助全身治疗的淋巴结阳性乳腺癌患者中，有几种针对淋巴结的活检技术，每种技术都有其内在的优势和劣势。TATTOO 试验的目的是评估碳墨染色阳性淋巴结作为一种避免辐射暴露、高成本和术前定位程序的靶向淋巴结活检方法的可行性和准确性。
本前瞻性多中心试验纳入了初始 cT1-4c cN1-3 cM0 浸润性乳腺癌患者。在开始新辅助全身治疗前，将碳混悬液注入最可疑的腋窝淋巴结。所有患者在完成新辅助全身治疗后均进行靶向淋巴结活检。对于腋窝降期的患者进行额外的前哨淋巴结活检，对于仍有可疑淋巴结的患者进行全腋窝淋巴结清扫。
共纳入 118 例患者，其中 110 例符合数据分析条件。靶向淋巴结的检出率为 93.6%（110 例中有 103 例），60%的前哨淋巴结与靶向淋巴结相同。靶向和前哨淋巴结活检（靶向腋窝清扫）的假阴性率为 9%。
碳墨染色后的靶向腋窝清扫具有较高的检出率、可接受的假阴性率，即使在资源有限的医疗环境中，也似乎可行用于临床。
