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Effect of preoperative injection of superparamagnetic iron oxide particles on rates of sentinel lymph node dissection in women undergoing surgery for ductal carcinoma in situ (SentiNot study)

Artikel i vetenskaplig tidskrift
Författare A. Karakatsanis
A. F. Hersi
L. Pistiolis
Roger Olofsson Bagge
P. M. Lykoudis
S. Eriksson
F. Warnberg
G. Nagy
I. Mohammed
M. Sundqvist
L. Bergkvist
A. Kwong
H. Olofsson
P. Stalberg
Grp SentiNot Trialists
Publicerad i British Journal of Surgery
Volym 106
Nummer/häfte 6
Sidor 720-+
ISSN 0007-1323
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för kirurgi
Sidor 720-+
Språk en
Länkar dx.doi.org/10.1002/bjs.11110
Ämnesord cancer american society, breast-cancer, biopsy, diagnosis, oncology, impact, nanoparticles, guidelines, management, dcis, Surgery
Ämneskategorier Cancer och onkologi

Sammanfattning

Background: One-fifth of patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS) have invasive breast cancer (IBC) on definitive histology. Sentinel lymph node dissection (SLND) is performed in almost half of women having surgery for DCIS in Sweden. The aim of the present study was to try to minimize unnecessary SLND by injecting superparamagnetic iron oxide (SPIO) nanoparticles at the time of primary breast surgery, enabling SLND to be performed later, if IBC is found in the primary specimen. Methods: Women with DCIS at high risk for the presence of invasion undergoing breast conservation, and patients with DCIS undergoing mastectomy were included. The primary outcome was whether this technique could reduce SLND. Secondary outcomes were number of SLNDs avoided, detection rate and procedure-related costs. Results: This was a preplanned interim analysis of 189 procedures. IBC was found in 47 and a secondary SLND was performed in 41 women. Thus, 78.3 per cent of patients avoided SLND (P<0.001). At reoperation, SPIO plus blue dye outperformed isotope and blue dye in detection of the sentinel node (40 of 40 versus 26 of 40 women; P<0.001). Costs were reduced by a mean of 24.5 per cent in women without IBC (3990 versus 5286; P<0.001). Conclusion: Marking the sentinel node with SPIO in women having surgery for DCIS was effective at avoiding unnecessary SLND in this study. Registration number: ISRCTN18430240 (http://www.isrctn.com).

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