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. 2022 Apr;17(2):166-171.
doi: 10.1159/000517208. Epub 2021 Jun 30.

Targeted Axillary Dissection after Chemotherapy: Feasibility Study with Clip and Carbon Dye Tattoo - Neotarget Trial

David Pinto  1 , Eva Batista  1 , Pedro Gouveia  1 , Carlos Mavioso  1 , João Anacleto  1 , Joana Ribeiro  1 , Berta Sousa  1 , Helena Gouveia  1 , Arlindo Ferreira  1 , Maurício Chumbo  1 , Maria Antónia Vasconcelos  1 , Mariana Correia  1 , Rita Canas Marques  1 , António Galzerano  1 , Maria José Brito  1 , Celeste Alves  1 , Fátima Cardoso  1 , Maria João Cardoso  1
Affiliations

Targeted Axillary Dissection after Chemotherapy: Feasibility Study with Clip and Carbon Dye Tattoo - Neotarget Trial

David Pinto et al. Breast Care (Basel). 2022 Apr.

Abstract

Background: Axillary staging in patients with complete response after neoadjuvant chemotherapy (NAC) is still controversial. Our objective was to test tattoo alone and subsequentially tattoo plus clip as markers in the targeted axillary dissection of ycN0 patients.

Methods: Prospective cohort of cT1-T3, cN1 (proven histologically), M0 patients scheduled to receive NAC. Exclusion criteria were lobular histology, prior axillary surgery, and clinical N2/3. In cohort 1 this positive node (Neotarget node) was tattooed at diagnosis. If ycN0, a targeted axillary dissection was performed. After an interim analysis with negative results we changed the protocol in order to do a double marking procedure (Cohort 2): the positive node was clipped at diagnosis and after NAC a tattoo was done before surgery.

Results: Thirteen patients in Cohort 1 and 18 patients in Cohort 2. Failure to identify the Neotarget node with multiple nodes retrieved in 9/13 (69%) of Cohort 1 patients. Also in 5/13 (38%) of Cohort 1 patients and 3/18 (17%) of Cohort 2 there was a failure to clearly identify tattooed nodes. In Cohort 2, clip identification by surgical specimen radiography allowed the identification of the tagged node in 17/18 (94,4%) of cases. The concordance between the clipped node and sentinel nodes was 16/18 (89%).

Conclusions: The introduction of double marking by clipping the metastatic node and verifying their removal by surgical specimen radiography, using carbon ink as a tracer, allowed the identification of the metastatic node in 94% of cases, with a simple, reproducible, and easy-to-implement targeted axillary dissection procedure.

Keywords: Axilla; Breast cancer; Carbon tattoo; Clip; Neoadjuvant chemotherapy.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Surgical specimen of the tattooed node retrieval − Neotarget node.
Fig. 2
Fig. 2
Surgical specimen radiography revealing the clipped node.
See this image and copyright information in PMC

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