General Surgery Service, Hospital Universitario Punta de Europa, Algeciras, 11207, Spain.
Eur J Surg Oncol. 2023 Jul;49(7):1184-1188. doi: 10.1016/j.ejso.2023.03.208. Epub 2023 Mar 10.
To be aware of the feasibility of targeted axillary dissection (TAD) injecting Technetium-labeled macroaggregated albumin (Tc-MAA) preoperatively into the clipped lymph node of patients with axillary complete clinical response (ycN0), after neoadjuvant chemotherapy (NAC) for breast cancer.
A retrospective observational study was performed on N1 patients with a clipped positive node and a clinically negative axilla (ycN0) after NAC in one center. The pretreatment positive lymph node was injected with Tc-MAA the day before surgery and identified intraoperatively with a radioguided occult lesion localization (ROLL) technique. Patients were subjected to a TAD with the intent of identifying the clipped node and other/s sentinel nodes through a standard sentinel lymph node biopsy (SLNB).
54 patients and 55 axillary clipped nodes were included. The clip was intraoperatively encountered in every patient, accomplishing a 100% detection rate, although in one case no lymphatic tissue could be found in the intraoperative frozen section. An axillary lymph node dissection (ALND) was avoided in 62.9% of the cases (34/54).
The use of the ROLL technique is a highly valuable tool since it allows a 100% success rate in retrieving the marker (and a 98.1% rate in detecting the clipped lymph node) in ycN0 breast cancer patients.
了解在接受新辅助化疗（NAC）后的乳腺癌腋部完全临床反应（ycN0）患者中，术前向夹闭的淋巴结注射锝标记的巨聚合白蛋白（Tc-MAA）进行靶向腋窝清扫（TAD）的可行性。
在一家中心对 N1 期腋部夹闭阳性淋巴结且临床腋部阴性（ycN0）的患者进行回顾性观察性研究。在术前一天，对预处理阳性淋巴结注射 Tc-MAA，并通过放射性引导隐匿性病变定位（ROLL）技术在术中识别。患者接受 TAD，目的是通过标准前哨淋巴结活检（SLNB）识别夹闭的淋巴结和其他/前哨淋巴结。
共纳入 54 例患者和 55 个腋部夹闭淋巴结。在每个患者中均在术中遇到了夹子，检出率为 100%，尽管在 1 例患者中，术中冷冻切片未发现淋巴组织。62.9%（34/54）的病例避免了腋淋巴结清扫术（ALND）。
ROLL 技术是一种非常有价值的工具，因为它可以 100%成功地回收标记物（夹闭淋巴结的检出率为 98.1%），用于 ycN0 乳腺癌患者。
