Kian Chin , Roger Olofsson Bagge , Nushin Mirzaei , Anikó Kovács , Henrik Leonhardt , Pontus Zaar , Andreas Karakatsanis , Eirini Pantiora , Staffan Eriksson , Maria Ekholm , Alastair Thompson , Peter Barry , Michael Boland , Vivian Man , Ava Kwong , Fredrik Wärnberg
{"title":"超顺磁性示踪剂和顺磁性种子用于在新辅助化疗前标记前哨淋巴结和指示性转移结节，以方便随后对乳腺癌患者进行前哨淋巴结活检和靶向腋窝清扫：可行性研究","authors":"Kian Chin , Roger Olofsson Bagge , Nushin Mirzaei , Anikó Kovács , Henrik Leonhardt , Pontus Zaar , Andreas Karakatsanis , Eirini Pantiora , Staffan Eriksson , Maria Ekholm , Alastair Thompson , Peter Barry , Michael Boland , Vivian Man , Ava Kwong , Fredrik Wärnberg","doi":"10.1016/j.soi.2024.100114","DOIUrl":null,"url":null,"abstract":"<div><h3>Background/objective</h3><div>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®).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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>.</div></div><div><h3>Synopsis</h3><div>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.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100114"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"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\",\"authors\":\"Kian Chin , Roger Olofsson Bagge , Nushin Mirzaei , Anikó Kovács , Henrik Leonhardt , Pontus Zaar , Andreas Karakatsanis , Eirini Pantiora , Staffan Eriksson , Maria Ekholm , Alastair Thompson , Peter Barry , Michael Boland , Vivian Man , Ava Kwong , Fredrik Wärnberg\",\"doi\":\"10.1016/j.soi.2024.100114\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background/objective</h3><div>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®).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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>.</div></div><div><h3>Synopsis</h3><div>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.</div></div>\",\"PeriodicalId\":101191,\"journal\":{\"name\":\"Surgical Oncology Insight\",\"volume\":\"2 1\",\"pages\":\"Article 100114\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-11-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgical Oncology Insight\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2950247024001233\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Oncology Insight","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2950247024001233","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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
Background/objective
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®).
Methods
Eighty 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.
Results
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 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.
Conclusions
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 Tc99m.
Synopsis
This 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.
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