J Surg Ultrasound.  2020 Nov;7(2):47-54. 10.46268/jsu.2020.7.2.47.

Targeted Axillary Biopsy with Preoperative Ultrasound-Guided Tattooing for Suspicious Axillary Lymph Nodes in Patients with Early Breast Cancer

• Jung JH
• Lee J
• Kim WW
• Park HY
• Park JY
• Lee SW
• Kim WH
• Kim HJ

• KMID: 2511909
• DOI: http://doi.org/10.46268/jsu.2020.7.2.47

Abstract

Purpose
This study evaluated the efficiency of preoperative ultrasound (US)-guided tattooing of the axillary lymph nodes with activated charcoal and the correlation between sonographically suspicious nodes and final histologic results by node-to-node analysis. The concordance rate between the tattooed nodes and sentinel nodes was also determined.
Methods
US-guided tattooing of sonographically suspicious axillary nodes was performed preoperatively by an injection of activated charcoal. The identification of black pigment and the concordance between the sentinel and tattooed nodes was evaluated.
Results
Regarding node-to-node analysis, the false-negative rate of US-fine needle aspiration (FNA) was 43.3%. The sensitivity and negative predictive values were 56.7% and 81.7%, respectively. The specificity and positive predictive values were 100%. The accuracy of US-FNA was 85.2%. In the final pathology, 45/125 patients (36.0%) had positive nodes, including two micrometastases. The false-negative rate of sentinel lymph node biopsy (SLNB) was 4.0%, but there were no skip metastases. The sensitivity and specificity of SLNB were 95.6% and 100%, respectively. The negative predictive value was 97.6%, and the positive predictive value was 100%. The accuracy of SLNB was 98.4%. In 117 of 125 patients (93.6%), there was concordance between the charcoal tattooed axillary lymph nodes and SLNs.
Conclusion
SLNB, in conjunction with US-guided tattooing of sonographically suspicious axillary lymph nodes, is a useful procedure to reduce the false-negative rate of SLNB and improve the accuracy of an intraoperative evaluation of axillary nodes in breast cancer patients. This paper proposes the concept of targeted axillary node biopsy with preoperative US-guided tattooing for the most accurate axillary staging in patients with breast cancer.

Keyword

Breast cancer; Lymph nodes; Axilla; Tattooing; Charcoal

Figure

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  Fig. 1 Ultrasound-guided localiza-tion using activated charcoal for the suspicious axillary lymph node.

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  Fig. 2 Identification of black pigment (A) and evaluation of concordance between sentinel and tattooed node (B).

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  Fig. 3 Schematic of patients. LN = lymph node; FNA = fine needle aspiration; US = ultrasound.

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