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

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

doi:10.32768/abc.202182143-148

Kelly S Myers ⁽¹⁾, Sachin Aggarwal ⁽²⁾, Eniola T Oluyemi ⁽³⁾, Mehran Habibi ⁽⁴⁾, Emily B Ambinder ⁽⁵⁾, Armina Azizi ⁽⁶⁾, Parvinder Sujlana ⁽⁷⁾, Jessica Hung ⁽⁸⁾, Nagi Khouri ⁽⁹⁾, David Eisner ⁽¹⁰⁾, Philip A Di Carlo ⁽¹¹⁾, Ashley M Cimino-Mathews ⁽¹²⁾, Melissa S Camp ⁽¹³⁾

(1) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(2) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(3) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(4) Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(5) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(6) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(7) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(8) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(9) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(10) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(11) Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(12) Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States,

(13) Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA, United States

https://doi.org/10.32768/abc.202182143-148

Issue
Vol 8, No 2: May 2021

Submitted
February 19, 2021

Published
April 15, 2021

Keywords:

Axilla, Sentinel Lymph node, Pre-operative localization, Ink, Interventional ultrasonography

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Abstract

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.

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