Pajcini Marlen, Wapnir Irene, Tsai Jacqueline, Edquilang Joanne, DeMartini Wendy, Ikeda Debra
Stanford University Medical Center, Department of Radiology, Stanford, CA, USA.
Stanford University Medical Center, Department of Surgery, Stanford, CA, USA.
J Breast Imaging. 2021 Sep 16;3(5):583-590. doi: 10.1093/jbi/wbab049.
To describe tattoo ink marking of axillary lymph nodes (TIMAN) and the elements leading to successful removal at sentinel lymph node biopsy (SLNB).
An IRB-approved retrospective image review was conducted of breast cancer patients who underwent SLNB after TIMAN from February 2013 to August 2017, noting patient and tattooed lymph node (TLN) features, initial biopsy type, time to surgery, if the TLN was identified at surgery, and correlation with the SLN. Cases were divided into two groups: the presurgical group, which had primary surgery, and the pre-neoadjuvant chemotherapy (NACT) group, which underwent surgery after completing NACT.
Of 30 patients who underwent 32 TIMAN procedures, 10 (33.3%) were presurgical and 20 (66.7%) were pre-NACT. The average lymph node (LN) depth from the skin was 1.6 cm, with an average of 0.3 mL of tattoo ink injected. Of 32 procedures, 29 (90.6%) had US images demonstrating the injection. Of these, 10 (34.5%) were injected in the LN cortex surface and 19 (65.5%) in the middle cortex. Seven (24.1%) were injected in the LN lateral aspect, 12 (41.4%) in the mid aspect, and 10 (34.5%) in the medial aspect. Of 32 LNs, 28 (87.5%) were tattooed immediately after initial biopsy and 4 (12.5%) at a later date. At SLNB, all 32 (100%) TLNs were identified, all correlated with the SLN, and 10 (31.3%) were positive for cancer.
Using an average of 0.3 mL of tattoo ink, all TLNs were successfully identified for removal at surgery, despite variability in LN and injection factors.
描述腋窝淋巴结纹身墨水标记法（TIMAN）以及前哨淋巴结活检（SLNB）时成功切除淋巴结的相关因素。
对2013年2月至2017年8月期间接受TIMAN后行SLNB的乳腺癌患者进行一项经机构审查委员会批准的回顾性图像分析，记录患者和纹身淋巴结（TLN）的特征、初始活检类型、手术时间、手术中是否识别出TLN以及与前哨淋巴结（SLN）的相关性。病例分为两组：接受初次手术的术前组和完成新辅助化疗（NACT）后接受手术的新辅助化疗前组。
30例患者接受了32次TIMAN操作，其中10例（33.3%）为术前组，20例（66.7%）为新辅助化疗前组。淋巴结（LN）距皮肤的平均深度为1.6厘米，平均注入0.3毫升纹身墨水。32次操作中，29次（90.6%）有超声图像显示注射情况。其中，10次（34.5%）注入LN皮质表面，19次（65.5%）注入皮质中部。7次（24.1%）注入LN外侧，12次（41.4%）注入中部，10次（34.5%）注入内侧。32个LN中，28个（87.5%）在初次活检后立即纹身，4个（12.5%）在之后纹身。在SLNB时，所有32个（100%）TLN均被识别，均与SLN相关，10个（31.3%）有癌症阳性。
尽管LN和注射因素存在差异，但平均使用0.3毫升纹身墨水，所有TLN在手术中均被成功识别以便切除。
