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Article: Superparamagnetic tracer and paramagnetic seed for marking of sentinel lymph nodes and index metastatic nodes before neoadjuvant chemotherapy to facilitate subsequent sentinel lymph node biopsy and targeted axillary dissection in breast cancer patients: a feasibility study
Title | Superparamagnetic tracer and paramagnetic seed for marking of sentinel lymph nodes and index metastatic nodes before neoadjuvant chemotherapy to facilitate subsequent sentinel lymph node biopsy and targeted axillary dissection in breast cancer patients: a feasibility study |
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Authors | |
Issue Date | 28-Nov-2024 |
Publisher | Elsevier |
Citation | Surgical Oncology Insight, 2024, v. 2, n. 1 How to Cite? |
Abstract | Background/objectiveAxillary staging after neoadjuvant chemotherapy (NACT) is associated with low detection and high false negative rates for sentinel lymph node biopsies (SLNB). The optimal method for lymphatic mapping is not determined. The aim was to study the feasibility of pre-marking axillary lymph nodes before NACT with a paramagnetic approach, utilizing superparamagnetic iron oxide nanoparticles (SPIO) and paramagnetic seeds (Magseed®). MethodsEighty patients with clinically node negative (cN0) and node positive (cN+) breast cancers were included. All had SPIO injected before and technetium-99m (Tc99m) after NACT. The index metastatic nodes (Index-met) were pre-marked with Magseed®). Primary endpoint was SLN and Index-met detection per patient. Secondary endpoints were concordance and reversed concordance of tracers. ResultsThirty-nine cN0 and 37 cN+ patients who underwent SLNB and targeted axillary dissections (TAD) were eligible for analyses. The overall SLN detection with SPIO and Tc99m were: 65/76 (86 %) vs. 60/76 (79 %), (95 % CI for difference between tracers 1 %-12 %, p = 0.01) respectively. The overall concordance and reversed concordance were 84/106 (79 %) vs. 84/193 (49 %), (95 % CI 21 %-39 %, p < 0.001) respectively. Detection of Index-met with Magseed® and Tc99m were 36/37 (97 %) vs. 20/36 (56 %), (95 % CI 27 %-59 %, p < 0.001) respectively. The median number of nodes retrieved with SPIO and Tc99m were 2 (IQR 1–3) and 1 (IQR 1–2) (p < 0.001), respectively. ConclusionsIt was feasible to perform axillary staging by pre-marking the relevant lymph nodes using a paramagnetic approach before NACT. Notably, a large proportion of SPIO marked lymph nodes were different from those marked by Tc99m. SynopsisThis study investigated using a paramagnetic approach for axillary nodal mapping before neoadjuvant chemotherapy comparing to a conventional mapping performed after chemotherapy. The results indicated feasibility of the paramagnetic method which also identified a different group of lymph nodes. However, these results require a further validation with a larger study. |
Persistent Identifier | http://hdl.handle.net/10722/352758 |
DC Field | Value | Language |
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dc.contributor.author | Chin, Kian | - |
dc.contributor.author | Bagge, Roger Olofsson | - |
dc.contributor.author | Mirzaei, Nushin | - |
dc.contributor.author | Kovács, Anikó | - |
dc.contributor.author | Leonhardt, Henrik | - |
dc.contributor.author | Zaar, Pontus | - |
dc.contributor.author | Karakatsanis, Andreas | - |
dc.contributor.author | Pantiora, Eirini | - |
dc.contributor.author | Eriksson, Staffan | - |
dc.contributor.author | Ekholm, Maria | - |
dc.contributor.author | Thompson, Alastair | - |
dc.contributor.author | Barry, Peter | - |
dc.contributor.author | Boland, Michael | - |
dc.contributor.author | Man, Vivian | - |
dc.contributor.author | Kwong, Ava | - |
dc.contributor.author | Wärnberg, Fredrik | - |
dc.date.accessioned | 2024-12-31T00:35:06Z | - |
dc.date.available | 2024-12-31T00:35:06Z | - |
dc.date.issued | 2024-11-28 | - |
dc.identifier.citation | Surgical Oncology Insight, 2024, v. 2, n. 1 | - |
dc.identifier.uri | http://hdl.handle.net/10722/352758 | - |
dc.description.abstract | <h3>Background/objective</h3><p>Axillary staging after neoadjuvant chemotherapy (NACT) is associated with low detection and high false negative rates for sentinel lymph node biopsies (SLNB). The optimal method for lymphatic mapping is not determined. The aim was to study the feasibility of pre-marking axillary lymph nodes before NACT with a paramagnetic approach, utilizing superparamagnetic iron oxide nanoparticles (SPIO) and paramagnetic seeds (Magseed®).</p><h3>Methods</h3><p>Eighty patients with clinically node negative (cN0) and node positive (cN+) breast cancers were included. All had SPIO injected before and technetium-99m (Tc<sup>99</sup><sup>m</sup>) after NACT. The index metastatic nodes (Index-met) were pre-marked with Magseed®<sup>)</sup>. Primary endpoint was SLN and Index-met detection per patient. Secondary endpoints were concordance and reversed concordance of tracers.</p><h3>Results</h3><p>Thirty-nine cN0 and 37 cN+ patients who underwent SLNB and targeted axillary dissections (TAD) were eligible for analyses. The overall SLN detection with SPIO and Tc<sup>99</sup><sup>m</sup> were: 65/76 (86 %) vs. 60/76 (79 %), (95 % CI for difference between tracers 1 %-12 %, p = 0.01) respectively. The overall concordance and reversed concordance were 84/106 (79 %) vs. 84/193 (49 %), (95 % CI 21 %-39 %, p < 0.001) respectively. Detection of Index-met with Magseed® and Tc<sup>99</sup><sup>m</sup> were 36/37 (97 %) vs. 20/36 (56 %), (95 % CI 27 %-59 %, p < 0.001) respectively. The median number of nodes retrieved with SPIO and Tc<sup>99</sup><sup>m</sup> were 2 (IQR 1–3) and 1 (IQR 1–2) (p < 0.001), respectively.</p><h3>Conclusions</h3><p>It was feasible to perform axillary staging by pre-marking the relevant lymph nodes using a paramagnetic approach before NACT. Notably, a large proportion of SPIO marked lymph nodes were different from those marked by Tc<sup>99</sup><sup>m</sup>.</p><h3>Synopsis</h3><p>This study investigated using a paramagnetic approach for axillary nodal mapping <em>before</em> neoadjuvant chemotherapy comparing to a conventional mapping performed after chemotherapy. The results indicated feasibility of the paramagnetic method which also identified a different group of lymph nodes. However, these results require a further validation with a larger study.</p> | - |
dc.language | eng | - |
dc.publisher | Elsevier | - |
dc.relation.ispartof | Surgical Oncology Insight | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.title | Superparamagnetic tracer and paramagnetic seed for marking of sentinel lymph nodes and index metastatic nodes before neoadjuvant chemotherapy to facilitate subsequent sentinel lymph node biopsy and targeted axillary dissection in breast cancer patients: a feasibility study | - |
dc.type | Article | - |
dc.identifier.doi | 10.1016/j.soi.2024.100114 | - |
dc.identifier.volume | 2 | - |
dc.identifier.issue | 1 | - |
dc.identifier.eissn | 2950-2470 | - |