SAVI SCOUT® 在前哨淋巴结定位新辅助化疗前对靶向腋窝清扫的转移性腋窝淋巴结的定位：一项初步研究。
SAVI SCOUT® localization of metastatic axillary lymph node prior to neoadjuvant chemotherapy for targeted axillary dissection: a pilot study.
机构信息
Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA.
Department of Radiology, University of California Los Angeles, Los Angeles, CA, USA.
出版信息
Breast Cancer Res Treat. 2022 Jan;191(1):107-114. doi: 10.1007/s10549-021-06416-z. Epub 2021 Oct 15.
PURPOSE
In clinically node-positive breast cancer, axillary staging after neoadjuvant chemotherapy (NAC) is optimized with targeted axillary dissection (TAD), which includes removal of the biopsy-proven metastatic lymph node (LN) in addition to sentinel lymph nodes (SLN). Localization of the clipped node is currently performed post-NAC; however, technical limitations can make detection and localization of the treated LN challenging. We prospectively evaluated the feasibility of localizing the metastatic LN with a SAVI SCOUT® reflector (SAVI) prior to NAC for targeted removal at surgery.
METHODS
Twenty-five patients with stage 2/3 breast cancer underwent ultrasound-guided localization of the biopsy-proven LN with SAVI prior to NAC. After NAC, patients with clinical response underwent TAD. Primary outcome measures were rate of successful localization, days between insertion of SAVI and axillary surgery, frequency of retrieval of clipped node, and frequency of SAVI-LN as SLN.
RESULTS
After NAC, 23/25 (92%) had clinical axillary down-staging and underwent TAD. Two patients with persistent palpable axillary disease underwent ALND for initial staging. Axillary surgery was performed at an average of 141 days post-SAVI insertion and the SAVI was successfully retrieved in all cases. Among 23 patients undergoing TAD, the SAVI was retrieved within a LN in all patients, whereas clip migration was observed in two patients. The median SLN removed was 4, and SAVI-LN was SLN in 22/23 patients. Axillary pCR rate was 44%.
CONCLUSION
Localizing a metastatic LN with SAVI reflector prior to NAC for targeted removal at surgery is feasible and may provide technical and logistical advantages over axillary localization post-NAC.
CLINICAL TRIAL REGISTRY
Clinical trials.gov identifier: NCT03411070.
目的
在新辅助化疗（NAC）后临床阳性腋窝的乳腺癌中，通过靶向腋窝解剖（TAD）优化腋窝分期，其中除了前哨淋巴结（SLN）之外，还包括切除经活检证实的转移性淋巴结（LN）。在 NAC 后进行夹闭 LN 的定位；然而，技术限制可能会使检测和定位治疗后的 LN 具有挑战性。我们前瞻性地评估了在 NAC 前使用 SAVI SCOUT®反射器（SAVI）对活检证实的 LN 进行定位的可行性，以便在手术中靶向切除。
方法
25 例 2/3 期乳腺癌患者在 NAC 前接受超声引导下 SAVI 定位活检证实的 LN。在 NAC 后，有临床反应的患者行 TAD。主要观察指标为成功定位率、SAVI 插入和腋窝手术之间的天数、夹闭 LN 的检出率以及 SAVI-LN 作为 SLN 的检出率。
结果
在 NAC 后，25 例中有 23 例（92%）临床腋窝降期，行 TAD。2 例持续触诊腋窝疾病的患者行 ALND 进行初始分期。腋窝手术平均在 SAVI 插入后 141 天进行，所有病例均成功取出 SAVI。在 23 例行 TAD 的患者中，SAVI 在所有患者的 LN 内均被取出，而在 2 例患者中观察到夹闭器迁移。切除的中位 SLN 为 4 个，SAVI-LN 是 22/23 例患者的 SLN。腋窝 pCR 率为 44%。
结论
在 NAC 前使用 SAVI 反射器对转移性 LN 进行定位，以便在手术中靶向切除是可行的，与 NAC 后腋窝定位相比，可能具有技术和后勤优势。
临床试验注册
ClinicalTrials.gov 标识符：NCT03411070。
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