Use of Magnetic Tracer and Magnetic Resonance Imaging for Sentinel Lymph Node Detection after Breast Cancer Recurrence and Previous Axillary Surgery

Author(s): Eva Vikhe Patil, Amalía Segerbard Planoudis, Kian Chin, Carlos Dussan, Henrik Leonhardt, Pontus Zaar, Pantelis Gialis, Fredrik Wärnberg

Introduction: Preoperative mapping increases the chance of finding the sentinel lymph node (SLN) in breast cancer (BC) patients with earlier axillary surgery. Today preoperative mapping is usually done using Technetium-99m (Tc99), and lymphoscintigraphy. An alternative method has been proposed using superparamagnetic iron oxide nanoparticles (SPIO) and magnetic resonance imaging (MRI). The aim of this study was to evaluate the feasibility of the magnetic technique for SLN mapping and perioperative localization in patients with breast cancer recurrence and previous axillary surgery. Method: Consecutive patients with breast cancer recurrence, earlier axillary surgery, and planned for SLN-biopsy were included. SPIO was injected and axillary MRI was conducted up to four weeks before surgery. Tc99 and lymphoscintigraphy was performed in all according to clinical routine. SLN detection per method was recorded. Results: In total 22 patients received both SPIO and Tc99. SLN mapping was successful by using SPIO/MRI in 73% (16/22) compared to 50% (11/22) by using Tc99/lymphoscintigraphy (p=0.12). Perioperative SLN detection was 17/22 (77%) using SPIO/magnetic probe and 10/22 (45%) using Tc99/gamma-probe (p=0.03). The magnetic technique detected 26 of totally 27 (96%) removed lymph nodes while Tc99/gamma-probe detected a signal in 12 (44%) (p<0.00003). Conclusion: It is feasible, and perhaps preferable, to perform a repeat SLN-biopsy using the magnetic technique in patients with recurrent breast cancer. Advantage with SPIO are the longer time frame that it remains in the lymph nodes which facilitate logistic planning for surgery as well as the less complicated process in handling the material compared to using Tc99.

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