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Supermagnetic Iron Oxide Tracer in Association with Radioisotope, for Sentinel Node Biopsy in Patients with Complete Axillary Response, After Neoadjuvant Chemoterapy: A Single Center, Prospective Study

Burlizzi S,Giacobbe F,R. E,Stasolla S,Villanucci A,D. A.,Niccoli A

Published 2021 in Journal of Surgical Research

ABSTRACT

Although NAC has been shown to be very effective in down staging of the axillary cavity and a complete pathological response (pCR) has been observed in 4070% of cases (above all in triple negative and Her2+ patients), it was assumed that a pathological response of the tumor alter axillary lymphatic rainage for lymphatic canal fibrosis with cellular debris, reducing the probability of sentinel node (SLN) idetification, with a likely increase in the percentage of false negatives rate (FNR), which as shown by SENTINA trial, where it stands at values of 16%, with a detection rate (DR) of 80%. In light of these observations, different surgical strategies have been put in place to reduce the FNR rate, in order to imporve the number of sentinel/parasentinel nodes and the identification rate (IR) during SNLB in c N+ yc N0 patients, such as the use of double tracer (like vital dye or superparamagnetic iron oxideSPIO, in association with Tc99), the clip placement in nodes involved before NAC and intraoperative ultrasound (IOUS). J Surg Res 2021; 4 (3): 465-472 DOI: 10.26502/jsr.10020157 Journal of Surgery and Research Vol. 4 No. 3 September 2021. [ISSN 2640-1002] 466 Here we will report our experience about the detection rate (DR) and the feasibility of the double tracers, SPIO (Magtrace) + Tc99. We enrolled 20 patients with diagnosis of invasive breast cancer with axillary metastasis, undergoing neodjuvant chemiotherapy and in axillary response after this (cN+ycN0). The overall lymph nodes removed were n°64 between sentinel and parasentinel nodes (52 with Magtrace and 29 with technetium, p-value 0.05). In 12/20 patients (60% of cases) the complementary use of Magtrace allowed us to reach a number of identified lymph nodes ≥ 3, avoinding axillary node dissection in 15/20 (75% of all patients). As demonstrated by our experience, still limited in number of cases, Magtrace® is a valid support in finding the SLN post NAC, both in terms of non-inferiority compared to Tc99, and as a complementary means to the latter in the 'to help us find a number ≥ 3 of LS, essential for breaking down the FNR.

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