SPIO (Magtrace®)-guided Sentinel Lymph Node Biopsy (SLNB) in early breast cancer - first monoinstitutional data and perspectives
Paepke S.1, Kiechle M.1, Karsten M.2, Blohmer J.-U.2, Schmidt G.1, Stassek J.1, Kühn T.3, Thill M.4
1Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Frauenheilkunde, München, Deutschland, 2Campus Charité Mitte (CCM), Klinik für Gynäkologie mit Brustzentrum, Berlin, Deutschland, 3Klinik für Frauenheilkunde und Geburtshilfe, Esslingen, Deutschland, 4Agaplesion Markus Krankenhaus, Gynäkologisches Krebszentrum, Frankfurt am Main, Deutschland
Aim: Super-paramagnetic iron oxide particle (SPIO)-techniques are reasonable alternatives to Tc99m-localization of SLNB with a similar detection rate but benefits regarding surgeon-guided and time-consuming operations. Concerns regarding staining and postoperative MRI were former reported. AGO-guidelines recommend SPIO-techniques as +/-. SLNB with 2 ml Magtrace® was implemented into clinical routine at our site.
Material: Magtrace® was injected peritumoral (BCS) or periareolar (M/NSM) in about 15 mm depth under the skin pre-operatively (OR-setting) followed by a 5 min massage from the injection site towards the axilla and additional 20 min waiting time. A first measurement for confirmation of a sufficient transcutaneous signal was done immediately before incision.
Methods: A retrospective documentation was done from 5-10/19 in 50 patients with breast conserving surgery (BCS), mastectomy (M) or nipple-sparing mastectomy (NSM). 24 % were treated pre-operatively with primary systemic chemotherapy.
Results: Age of the patients was between 33 - 83 years. SLN-detection rate was 94.0%. Operation time (only SLNB) ranges from 3 to 28 min (median: 8 min). Staining is not reported using injection techniques not direct subcutaneously.
Conclusion: SPIO-guided SLNB was easy to handle and sufficient independent on PST and targeted axillary dissection. With an increasing number of procedures and prospective clinical trials including the 1ml-injection dosage SPIO-guided SLNB will be established as an alternative to ICG-/ Technetium-based procedures and implemented in the AXSANA-Registry of the EUBREAST. An ongoing trial (Charité; Berlin) will focus on efficacy in direct comparison to Tc99m-based procedures.
Detailed results including after care imaging reports will be presented.