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Feasibility of Charcoal Tattooing of Cytology-Proven Metastatic Axillary Lymph Node at Diagnosis and Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients

 Seho Park  ;  Ja Seung Koo  ;  Gun Min Kim  ;  Joohyuk Sohn  ;  Seung Il Kim  ;  Young Up Cho  ;  Byeong-Woo Park  ;  Vivian Youngjean Park  ;  Jung Hyun Yoon  ;  Hee Jung Moon  ;  Min Jung Kim  ;  Eun-Kyung Kim 
 Cancer Research and Treatment, Vol.50(3) : 801-812, 2018 
Journal Title
 Cancer Research and Treatment 
Issue Date
Charcoal ; Neoadjuvant therapy ; Sentinel lymph node biopsy ; Tattoo ; Breast neoplasms
Purpose: Sentinel lymph node biopsy (SLNB) can be performed when node-positive disease is converted to node-negative status after neoadjuvant chemotherapy (NCT). Tattooing nodes might improve accuracy but supportive data are limited. This study aimed to investigate the feasibility of charcoal tattooing metastatic axillary lymph node (ALN) at presentation followed by SLNB after NCT in breast cancers. Materials and Methods: Twenty patientswith cytology-proven node metastases prospectively underwent charcoal tattooing at diagnosis. SLNB using dual tracers and axillary surgery after NCT were then performed. The detection rate of tattooed node and diagnostic performance of SLNB were analyzed. Results: All patients underwent charcoal tattooingwithout significant morbidity. Sentinel and tattooed nodes could be detected during surgery after NCT. Nodal pathologic complete response was achieved in 10 patients. Overall sensitivity, false-negative rate (FNR), negative predictive value, and accuracy of hot/blue SLNB were 80.0%, 20.0%, 83.3%, and 90.0%, respectively. Retrieving more nodes and favorable nodal response were associated with improved performance. The best accuracy was observed when excised tattooed node was calculated together (FNR, 0.0%). Cold/non-blue tattooed nodes of five patients were removed during non-sentinel axillary surgery but clinicopathological parameters did not differ compared to patients with hot/blue tattooed node detected during SLNB, suggesting the importance of the tattooing procedure itself to improve performance. Conclusion: Charcoal tattooing of cytology-confirmed metastatic ALN at presentation is technically feasible and does not limit SLNB after NCT. The tattooing procedure without additional preoperative localization is advantageous for improving the diagnostic performance of SLNB in this setting.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
구자승(Koo, Ja Seung) ORCID logo https://orcid.org/0000-0003-4546-4709
김건민(Kim, Gun Min) ORCID logo https://orcid.org/0000-0001-9167-8682
김민정(Kim, Min Jung) ORCID logo https://orcid.org/0000-0003-4949-1237
김승일(Kim, Seung Il)
김은경(Kim, Eun-Kyung) ORCID logo https://orcid.org/0000-0002-3368-5013
문희정(Moon, Hee Jung) ORCID logo https://orcid.org/0000-0002-5643-5885
박병우(Park, Byeong Woo) ORCID logo https://orcid.org/0000-0003-1353-2607
박세호(Park, Se Ho) ORCID logo https://orcid.org/0000-0001-8089-2755
박영진(Park, Vivian Youngjean) ORCID logo https://orcid.org/0000-0002-5135-4058
손주혁(Sohn, Joo Hyuk) ORCID logo https://orcid.org/0000-0002-2303-2764
윤정현(Yoon, Jung Hyun) ORCID logo https://orcid.org/0000-0002-2100-3513
조영업(Cho, Young Up) ORCID logo https://orcid.org/0000-0003-2936-410X
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