Hyde Brenda, Geske Jennifer, Lee Christine
Mayo Clinic, Department of Radiology, Division of Breast Imaging and Intervention, Rochester, MN.
Mayo Clinic, Department of Biomedical Statistics and Informatics, Rochester, MN.
J Breast Imaging. 2019 Sep 4;1(3):223-229. doi: 10.1093/jbi/wbz032.
The objective of this retrospective study is to characterize challenges with ultrasound (US)-guided localization of clipped metastatic axillary lymph nodes after neoadjuvant chemotherapy.
After institutional review board approval, our radiology database was searched for all radioactive seed localizations (RSLs), which use a low-dose radioactive isotope, Iodine-125, performed for clipped axillary lymph nodes between January 1, 2016, and December 31, 2018. The details of each procedure were reviewed. RSL was defined to be successful if US-guidance was used, and postlocalization imaging showed the seed was no more than 1 cm away from the target. Cause and subsequent management of unsuccessful localizations were documented.
During the study period, 139 clipped axillary lymph nodes (in 138 women and 1 man) were scheduled for preoperative RSL. The overall success rate of RSL was 106/139 (76%). The number of unsuccessful localizations was 10/37 (27%) in 2016, 7/39 (18%) in 2017, and 16/63 (25%) in 2018, with a total unsuccessful case frequency of 33/139 (24%) over the entire study period. The mean time interval between marker placement and localization was 6.0 months (range 0.4-18.1 months). The coil biopsy marker was the most frequently used marker.
Preoperative US-guided I-125 seed localization of clipped metastatic axillary lymph nodes is suboptimal or unsuccessful 24% of the time. Other options for non-US imaging-guided localizations, such as tomosynthesis, are available for consideration when US detection is unsuccessful.
本回顾性研究的目的是描述新辅助化疗后超声（US）引导下定位夹闭的转移性腋窝淋巴结所面临的挑战。
经机构审查委员会批准后，在我们的放射学数据库中搜索2016年1月1日至2018年12月31日期间对夹闭的腋窝淋巴结进行的所有放射性种子定位（RSL），该定位使用低剂量放射性同位素碘-125。审查了每个操作的详细信息。如果使用了超声引导且定位后成像显示种子与目标的距离不超过1厘米，则RSL被定义为成功。记录了定位失败的原因及后续处理。
在研究期间，计划对139个夹闭的腋窝淋巴结（138名女性和1名男性）进行术前RSL。RSL的总体成功率为106/139（76%）。2016年定位失败的数量为10/37（27%），2017年为7/39（18%），2018年为16/63（25%），整个研究期间定位失败的总病例频率为33/139（24%）。标记放置与定位之间的平均时间间隔为6.0个月（范围0.4 - 18.1个月）。线圈活检标记是最常用的标记。
术前超声引导下对夹闭的转移性腋窝淋巴结进行碘-125种子定位有24%的时间效果欠佳或不成功。当超声检测不成功时，可考虑其他非超声成像引导定位的选项，如断层合成成像。
