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Intraoperative Ultrasound-Guided Excision of Axillary Clip in Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Therapy (ILINA Trial)

A New Tool to Guide the Excision of the Clipped Node After Neoadjuvant Treatment

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The accuracy of sentinel lymph node biopsy (SLNB) after neoadjuvant therapy (NAT) has been improved with the placement of a clip in the positive node prior to treatment. Several methods have been described for clipped node excision during SLNB after NAT. We assessed the feasibility of intraoperative ultrasound (IOUS)-guided excision of the clipped node during SLNB and investigated whether the accuracy of SLNB is improved.

Methods

After approval by the Institutional Ethics Committee, all breast cancer patients undergoing NAT had an US-visible clip placed in the positive node. The ILINA trial consisted of IOUS-guided excision of the clipped node along with SLNB and axillary lymph node dissection (ALND).

Results

Forty-six patients had a clip placed in the positive node. In two (4.3%) cases, the clip could not be seen prior to surgery and the patient underwent ALND; however, the clipped node was successfully removed by IOUS-guided excision in 44 patients. Thirty-five patients (79.5%) underwent SLNB along with IOUS-guided excision of the clipped node and ALND, and were subsequently included in the ILINA trial. Nine patients were not included (five patients with SLNB only and four patients with ALND without SLNB). SLNB matched the clipped node in 27 (77%) patients. The false negative rate for the ILINA protocol was 4.1% (95% confidence interval 0.1–21.1%).

Conclusions

IOUS-guided excision of the axillary clipped node after NAT was feasible, safe, and successful in 100% of cases. The ILINA trial is accurate in predicting axillary nodal status after NAT.

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Authors and Affiliations

  1. Breast Surgical Oncology, Breast Cancer Center, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Christian Siso MD, Antonio Esgueva-Colmenarejo MD, Martin Espinosa-Bravo MD, Octavi Cordoba MD, Roberto Rodriguez MD & Isabel T. Rubio MD, PhD

  2. Breast Imaging Unit, Department of Radiology, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Juan de Torres MD & Neus Rus MD

  3. Universitat Autònoma de Barcelona, Barcelona, Spain

    Antonio Esgueva-Colmenarejo MD, Martin Espinosa-Bravo MD, Octavi Cordoba MD, Roberto Rodriguez MD, Vicente Peg MD & Isabel T. Rubio MD, PhD

  4. Department of Pathology, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Vicente Peg MD

  5. Spanish Biomedical Research Network Centre in Oncology (CIBERONC), Barcelona, Spain

    Vicente Peg MD

Authors
  1. Christian Siso MD
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  2. Juan de Torres MD
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  3. Antonio Esgueva-Colmenarejo MD
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  4. Martin Espinosa-Bravo MD
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  5. Neus Rus MD
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  6. Octavi Cordoba MD
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  7. Roberto Rodriguez MD
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  8. Vicente Peg MD
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  9. Isabel T. Rubio MD, PhD
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Corresponding author

Correspondence to Isabel T. Rubio MD, PhD.

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All authors declare that they have no potential conflicts of interest to declare.

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Siso, C., de Torres, J., Esgueva-Colmenarejo, A. et al. Intraoperative Ultrasound-Guided Excision of Axillary Clip in Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Therapy (ILINA Trial). Ann Surg Oncol 25, 784–791 (2018). https://doi.org/10.1245/s10434-017-6270-z

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  • DOI: https://doi.org/10.1245/s10434-017-6270-z

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