Premarking of Axillary Nodes Before Start of Neoadjuvant Chemotherapy Using Magnetic Approach
Status:
Recruiting
Trial end date:
2023-07-01
Target enrollment:
Participant gender:
Summary
Breast cancer is one of the commonest types of cancers in females. Treatments include surgery
followed by anti-estrogen therapy, radiotherapy and chemotherapy. During breast surgery, the
surgeon removes the cancer from the breast and lymph nodes (glands) from the armpit.
Historically, all armpit lymph nodes were surgically removed but this approach is associated
long term problems of arm swelling. In more recent times, an increasingly more selective
approach is used to treat the armpit nodes. In the presence of cancer spreads in the nodes,
an axillary clearance surgery is done otherwise, only the first node(s) also called sentinel
node(s) that drain fluids from the cancer, is surgically removed. The identification of nodes
using the latter approach is helped by injecting a tracer in the breast and via the lymphatic
channels, the tracer is then concentrated in the sentinel nodes.
Over recent years, neoadjuvant (preoperative) chemotherapy is being increasingly used to
treat breast cancers. This treatment approach can lead up to a large of number of complete
cancer response. This in turn can cause difficulties in locating the breast cancer / armpit
nodes during surgery after the chemotherapy.
New developments like superparamagnetic iron oxide nanoparticles (SPIO or MagTrace®) has been
used as an alternate liquid tracer to mark sentinel nodes to facilitate armpit surgery. In
addition, small magnetic clip called Magseed® has also been developed which can be inserted
into the relevant lymph nodes thereby marking their anatomical position to facilitate
surgery. Both MagTrace and Magseed can be used to pre-mark the cancer and armpit nodes before
the start of neoadjuvant chemotherapy. In theory, premarking armpit nodes using a magnetic
approach is associated with better surgical accuracy in the armpit but there is limited
supporting data.
Therefore, this study aims to investigate the feasibility of premarking armpit nodes, with or
without cancer spread, using magtrace and magseed respectively before patients undergo
neoadjuvant chemotherapy.