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A Comparison of Skin Staining after Sentinel Lymph Node Biopsy in Women Undergoing Breast Cancer Surgery Using Blue Dye and Superparamagnetic Iron Oxide Nanoparticle (SPIO) Tracers
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Vastmanlands Cty Hosp, Dept Surg, S-72189 Västerås, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Plast Surg, S-41345 Gothenburg, Sweden..
Soder Sjukhuset, Dept Surg, S-11883 Stockholm, Sweden..
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2022 (English)In: Cancers, ISSN 2072-6694, Vol. 14, no 23, article id 6017Article in journal (Refereed) Published
Abstract [en]

Simple Summary Both superparamagnetic iron oxide nanoparticles (SPIO) and blue dye (BD) have been reported to cause skin staining after breast-conserving surgery. SPIO is a novel tracer that has been shown to identify sentinel lymph nodes (SLNs) in patients with breast cancer. Our study was the first to compare the incidence and size of skin staining between the two tracers. We reported on these outcomes in a preplanned secondary analysis of a prospective clinical trial in which women received both SPIO and BD. This study investigated whether there was a difference in the incidence and size of skin staining between SPIO and BD after SLN-dissection. In all, 270 women were operated on with breast-conserving surgery and received SPIO, and 204 of these women also received BD. After 24 months of follow up, there was no statistically significant difference between the two tracers with regard to the size and incidence of skin staining. Superparamagnetic iron oxide nanoparticles (SPIO) are a tracer for sentinel lymph node (SLN) detection. In a preplanned secondary analysis of a prospective clinical trial (SentiDose) we reported on skin staining after SPIO and blue dye (BD) injections. For SPIO, either a 1.5 mL retroareolar injection on the day of surgery or a 1.0 mL peritumoral/retroareolar injection 1-7 days before surgery was given. A 1.0 mL sub-/intradermal periareolar injection of BD was also administered to all these women. Staining was then assessed at 6, 12 and 24 months after surgery. A total of 270 women received SPIO and were operated on with breast-conserving surgery. Of these, 204 women also received BD. A total of 58 (21.5%) women had an SPIO stain 6 months postoperatively with a median size of 6.8 cm(2) (p = 0.56), while 51 (25.0%) had a BD stain with a median size of 8.5 cm(2) (p = 0.93). The incidence and size of SPIO and BD staining decreased over time reciprocally. At 24 months, the incidence and median size of SPIO was 23 (8.6%) and 4 cm(2), respectively. For BD, the incidence was 14 (6.3%, p = 0.13), and the median size was 3.5 cm(2) (p = 0.18). There was, therefore, no statistically significant difference in the incidence or size of skin staining between SPIO and BD over time.

Place, publisher, year, edition, pages
MDPI, 2022. Vol. 14, no 23, article id 6017
Keywords [en]
sentinel lymph node biopsy, breast cancer, blue dye, superparamagnetic iron oxide, magnetic tracer, sentinel lymph node, skin staining
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-492358DOI: 10.3390/cancers14236017ISI: 000897533100001PubMedID: 36497498OAI: oai:DiVA.org:uu-492358DiVA, id: diva2:1723936
Funder
The Breast Cancer FoundationAvailable from: 2023-01-04 Created: 2023-01-04 Last updated: 2024-04-03Bibliographically approved
In thesis
1. Optimizing the magnetic tracer technique for sentinel lymph node detection and tumour localization in breast cancer surgery
Open this publication in new window or tab >>Optimizing the magnetic tracer technique for sentinel lymph node detection and tumour localization in breast cancer surgery
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Breast cancer is the most common form of cancer in women, and the primary treatment modalities are still breast-conserving surgery (BCS) and sentinel lymph node dissection (SLND) in most cases. Superparamagnetic iron oxide nanoparticles (SPIO) are gaining momentum as a tracer for sentinel lymph node detection. The aim of this thesis is to further refine the magnetic method and investigate its postoperative effects.

Paper I: This feasibility study, involving 79 patients, explored the use of SPIO-guided Magnetic resonance imaging (MRI)-lymphography and magnetic-guided axillary ultrasound (MagUS) with core biopsy for sentinel lymph node (SLN) localization and SLN status. MagUS, outperformed baseline axillary ultrasound and successfully traced SLNs in all cases, detecting macro-metastases accurately and missed only one micro-metastasis. The findings suggest that the MagUS technique enables minimally invasive approach in axillary mapping that can meet tailored patient needs and reduce the need for diagnostic surgery. 

Paper II: This study aimed to compare skin staining incidence and size between different doses of SPIO and blue dye (BD), evaluating their persistence over time. Among 270 women receiving SPIO, 204 also received BD. At six months, 21.5% had SPIO stains and 25% had BD stains Incidence and size decreased reciprocally, with no significant difference between the tracers regarding skin staining after 24 months. 

Paper III: This study compared the magnetic technique using Magseed® for non-palpable breast tumor localization with guidewire localization and SPIO for sentinel lymph node detection. In a prospective analysis of 426 women, reoperation rates, resection ratios, and SLN detection were assessed. No significant differences were found between the techniques in terms of re-excisions, resection ratios, or SLN detection. However, the magnetic technique showed more successful localizations, shorter operation time, and better overall experience among surgeons, radiologists, and theater coordinators, making it a good alternative for BCS.

Paper IV: In this prospective observational study, the impact of postoperative MRI outcome was explored in patients undergoing BCS with a peritumoral SPIO injection for SLN detection. The study affirms SPIO as a safe tracer for SLN detection without compromising MRI interpretation after BCS, ensuring reliable breast cancer recurrence assessment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2024. p. 58
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2036
Keywords
Breast Cancer, Sentinel Node, Super paramagnetic ironoxide nanoparticles, SPIO, Skin Staining, Magnetic resonance imaging, magnetic seed, guidewire
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-525195 (URN)978-91-513-2073-1 (ISBN)
Public defence
2024-05-16, Ingång 21, Västmanlands Sjukhus Västerås, Västerås, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2024-04-23 Created: 2024-03-18 Last updated: 2024-05-08

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Eriksson, StaffanKarakatsanis, AndreasWärnberg, Fredrik

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Jazrawi, AllanEriksson, StaffanKarakatsanis, AndreasWärnberg, Fredrik
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