Delayed Sentinel Lymph Node Dissection in Patients with a Preoperative Diagnosis of Ductal Cancer In Situ by Preoperative Injection with Superparamagnetic Iron Oxide (SPIO) Nanoparticles: The SentiNot Study

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Abstract

Background

Difficulty in preoperatively assessing the risk for occult invasion or surgery that precludes future accurate axillary mapping in patients with ductal cancer in situ (DCIS) account for overutilization of SLND.

Methods

Prospective, multicenter, cohort study, including women with any DCIS planned for mastectomy or DCIS grade 2 and > 20 mm, any DCIS grade 3, any mass-forming DCIS and any planned surgery. Patients received an interstitial SPIO injection during breast surgery, but no upfront SLND was performed. If invasion was identified on final pathology, delayed SLND (d-SLND) was performed separately with the coadministration of isotope ± blue dye (BD). Study outcomes were proportion of upfront SLNDs that were avoided, detection rates during d-SLND, and impact on healthcare costs.

Results

In total, 78.7% of study participants ( N = 254, mean age 60 years, mean DCIS size 37.8 mm) avoided upfront SLND. On d-SLND (median 28 days, range 9–46), SPIO outperformed Tc ⁹⁹ with (98.2% vs. 63.6%, p < 0.001) or without BD (92.7% vs. 50.9%, p < 0.001) and had higher nodal detection rate (86.9% vs. 32.3%, p < 0.001) and with BD (93.9% vs. 41.4%, p < 0.001). Only 27.9% of all SLNs retrieved were concordant for Tc ⁹⁹ and SPIO. Type of breast procedure (WLE vs. oncoplastic BCT vs. mastectomy) affected these outcomes and accounted for the low performance of Tc ⁹⁹ ( p < 0.001). d-SLND resulted in a 28.1% total cost containment for women with pure DCIS on final pathology (4190 vs. 5828 USD, p < 0.001).

Conclusions

Marking the SLN with SPIO may avoid overtreatment and allow for accurate d-SLND in patients with DCIS.

Supplementary Information

The online version contains supplementary material available at 10.1245/s10434-022-13064-0.

Related collections

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Author and article information

Contributors

Andreas Karakatsanis: andreas.karakatsanis@surgsci.uu.se

Journal

Journal ID (nlm-ta): Ann Surg Oncol

Journal ID (iso-abbrev): Ann Surg Oncol

Title: Annals of Surgical Oncology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1068-9265

ISSN (Electronic): 1534-4681

Publication date (Electronic): 31 January 2023

Publication date PMC-release: 31 January 2023

Publication date (Print): 2023

Volume: 30

Issue: 7

Pages: 4064-4072

Affiliations

[1 ]GRID grid.8993.b, ISNI 0000 0004 1936 9457, Department of Surgical Sciences, , Uppsala University, ; Uppsala, Sweden

[2 ]GRID grid.412354.5, ISNI 0000 0001 2351 3333, Department of Surgery, , Uppsala University Hospital, ; Uppsala, Sweden

[3 ]GRID grid.8993.b, ISNI 0000 0004 1936 9457, Centre for Clinical Research, , Uppsala University, ; Västerås, Sweden

[4 ]Department of Surgery, Västmanland County Hospital, Västerås, Sweden

[5 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, Department of Surgery, Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, , University of Gothenburg, Sahlgrenska Academy, ; Gothenburg, Sweden

[6 ]GRID grid.1649.a, ISNI 000000009445082X, Department of Surgery, , Sahlgrenska University Hospital, ; Gothenburg, Sweden

[7 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, Wallenberg Centre for Molecular and Translational Medicine, , University of Gothenburg, ; Gothenburg, Sweden

[8 ]GRID grid.411384.b, ISNI 0000 0000 9309 6304, Breast Unit, Department of Surgery, , Linköping University Hospital, ; Linköping, Sweden

[9 ]GRID grid.194645.b, ISNI 0000000121742757, Department of Surgery, , University of Hong Kong, ; Hong Kong, Hong Kong SAR China

[10 ]GRID grid.194645.b, ISNI 0000000121742757, Department of Surgery, , The University of Hong, Kong-Shen Zhen Hospital, ; Shenzhen, China

[11 ]GRID grid.414329.9, ISNI 0000 0004 1764 7097, Department of Surgery, , Hong Kong Sanatorium and Hospital, ; Hong Kong, Hong Kong SAR China

Article

Publisher ID: 13064

DOI: 10.1245/s10434-022-13064-0

PMC ID: 10250503

PubMed ID: 36719570

SO-VID: 255d07c9-aeb6-49e8-836d-7f7e575585ef

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 1 November 2021

Date accepted : 22 December 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100009230, Landstinget i Uppsala län;

Funded by: Bröstcancerförbundet

Funded by: Uppsala University

Open Access :

Open access funding provided by Uppsala University.

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Data availability: