Abstract
Introduction
Clipping and selective removal of axillary lymph nodes in breast cancer patients presenting
with initially node-positive disease and achieving a nodal downstaging after primary
systemic therapy is a less invasive method for axillary staging. An imaging guided
localization and successful extirpation of these clipped lymph nodes is not possible
in all patients. To date no follow-up data regarding patients with lost clips are
available.
Material and methods
The oncological outcome of all participants of the CLIP-study and the results of postoperative
axillary imaging in those patients with unproven clip resection are presented.
Results
A total of thirty patients were included into the pilot study. In ten of these patients
(33%) the removal of the clipped axillary lymph node could not be verified by intraoperative
radiograph. Postoperative imaging did not find lost clips in eight of these ten patients
(80%). The lost clip was detected in two patients after surgery (20%), by mammography
in one patient during routine follow-up and by computed tomography scan in one patient
before radiotherapy. After a median follow-up of 40 months, 26 (87%) patients were
still alive. Seven patients (23%) developed distant recurrent disease. No local or
axillary recurrences were observed.
Conclusion
Lost clips were detected by postoperative imaging only in a minority of patients.
The impact of lost clips on axillary recurrences in breast cancer patients is still
unclear and should be further clarified in larger, multicentric trials.
Keywords
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Article info
Publication history
Published online: April 30, 2021
Accepted:
April 26,
2021
Received in revised form:
April 18,
2021
Received:
March 10,
2021
Identification
Copyright
© 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
