Pre-Operative Localization of Axillary Lymph Nodes with Tattoo Ink: A Preliminary Report

• Main Authors: Kelly S Myers, Sachin Aggarwal, Eniola T Oluyemi, Mehran Habibi, Emily B Ambinder, Armina Azizi, Parvinder Sujlana, Jessica Hung, Nagi Khouri, David Eisner, Philip A Di Carlo, Ashley M Cimino-Mathews, Melissa S Camp
• Format: Article
• Language: English
• Published: Kaviani Breast Disease Institute 2021-04-01
• Series: Archives of Breast Cancer
• Subjects: Axilla; Sentinel Lymph node; Pre-operative localization; Ink; Interventional ultrasonography
• Online Access: https://archbreastcancer.com/index.php/abc/article/view/379

Background: Pre-operative localization options in the axilla are limited. This study aimed to explore the utility of pre-operative localization of axillary lymph nodes using tattoo ink with multidisciplinary correlations. Methods: In this prospective, Institutional Review Board (IRB)-approved study, 19 lymph nodes in 17 patients underwent pre-operative localization with ultrasound-guided injection of Spot tattoo ink. The success rate of intraoperative identification of the tattooed node as well as the frequency in which the tattooed node was also a sentinel node were recorded. Radiologic, surgical and pathologic images were collected. Results: Tattoo ink localization was successful in 16/17 (94.1%) of patients. Tattoo ink did not hinder pathologic evaluation in any cases but was taken up by additional adjacent nodes in 1/17 successful localizations (5.9%). Successful sentinel lymph node biopsy (SLNB) occurred in 13 patients in whom 14 lymph nodes underwent pre-operative tattoo ink localization. Nine of the 14 (64.2%) tattooed lymph nodes were also a sentinel node. Conclusion: In this study, pre-operative localization of axillary lymph nodes with tattoo ink was highly successful In patients undergoing SLNB, a significant number of the tattooed nodes were not sentinel nodes (35.8%), suggesting the importance of targeted lymph node excision in addition to SLNB.