Ultrasound-guided preoperative lymph node localization for subsequent targeted axillary dissection using a tumor marker coil
Moreth M.1, Kaltenbach B.2, Bufe A.3, Hoedl P.4, Bretschneider C.1, Herröder N.3, Müller-Schimpfle M.1
1Klinikum Frankfurt Höchst, Radiologie, Frankfurt am Main, Deutschland, 2Universitätsklinikum Frankfurt, Radiologie, Frankfurt am Main, Deutschland, 3Klinikum Frankfurt Höchst, Gynäkologie und Geburtshilfe, Frankfurt am Main, Deutschland, 4Klinikum Frankfurt Höchst, Pathologie, Frankfurt am Main, Deutschland
Purpose: To assess an ultrasound (US) - guided localization technique of pathologic lymph nodes for subsequent targeted axillary dissection (TAD) in breast cancer, particularly after neoadjuvant therapy.
Materials and Methods: Until 12/2019 61 patients were identified who had undergone single or multiple US-guided marking of either one or two axillary lymph nodes with biopsy - proven or US/CT-suspected breast cancer involvement (n = 53 after neoadjuvant chemotherapy). A coil (MReyeŽ Breast Localization Coil, Cook Medical) was used as a market introduced tumor marker. Preoperatively, US-guided wire localization of the coil was performed. Intra-operative specimen radiography was used to prove a complete marker removal.
Results: So far, preoperative wire localizations were analyzed that were scheduled for 46 patients with 58 coils. Without difficulty 53 coils (91%) could be localized. In five cases (9%) the coil could not be identified clearly via ultrasound. Therefore, fluoroscopy was used to identify the exact location of four of the coils, providing for a US-guided wire marking of 57 coils. All implanted coils were retrieved during primary surgery, which resulted in a 100% retrieval rate. No significant complications occurred.
Conclusion: US-guided coil marking of biopsy-proven positive lymph nodes and intraoperative retrieval of these lymph nodes by US-guided preoperative wire localization of the coils is a technically feasible and safe method to enable targeted axillary dissection, particularly after neoadjuvant therapy.