title: Initial results with preoperative tattooing of biopsied axillary lymph nodes and correlation to sentinel lymph nodes in breast cancer patients.
abstract: BACKGROUND
  Pretreatment evaluation of axillary lymph nodes (ALNs) and marking of biopsied nodes in patients with newly diagnosed breast cancer is becoming routine practice. We sought to test tattooing of biopsied ALNs with a sterile black carbon suspension (Spot™). The intraoperative success of identifying tattooed ALNs and their concordance to sentinel nodes was determined.
  
  
  METHODS
  Women with suspicious ALNs and newly diagnosed breast cancer underwent palpation and/or ultrasound-guided fine needle aspiration or core needle biopsy, followed by injection of 0.1 to 0.5 ml of Spot™ ink into the cortex of ALNs and adjacent soft tissue. Group I underwent surgery first, and group II underwent neoadjuvant therapy followed by surgery. Identification of black pigment and concordance between sentinel and tattooed nodes was evaluated.
  
  
  RESULTS
  Twenty-eight patients were tattooed, 16 in group I and 12 in group II. Seventeen cases had evidence of atypia or metastases, 8 (50 %) in group I and 9 (75 %) in group II. Average number of days from tattooing to surgery was 22.9 (group I) and 130 (group II). Black tattoo ink was visualized intraoperatively in all cases, except one case with microscopic black pigment only. Fourteen group I and 10 group II patients had black pigment on histological examination of ALNs. Sentinel nodes corresponded to tattooed nodes in all except one group I patient with a tattooed non-sentinel node.
  
  
  CONCLUSIONS
  Tattooed nodes are visible intraoperatively, even months later. This approach obviates the need for additional localization procedures during axillary staging.
authors.affiliation: Department of Surgery, Stanford University School of Medicine and the Stanford Cancer Institute, Stanford, CA, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Choy
authors.forename: Jafi
authors.initials: J
authors.lastname: Lipson
authors.forename: Catherine
authors.initials: C
authors.lastname: Porter
authors.forename: Michael
authors.initials: M
authors.lastname: Ozawa
authors.forename: Anne
authors.initials: A
authors.lastname: Kieryn
authors.forename: Sunita
authors.initials: S
authors.lastname: Pal
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kao
authors.forename: Long
authors.initials: L
authors.lastname: Trinh
authors.forename: Amanda
authors.initials: A
authors.lastname: Wheeler
authors.forename: Debra
authors.initials: D
authors.lastname: Ikeda
authors.forename: Kristin
authors.initials: K
authors.lastname: Jensen
authors.forename: Kimberly
authors.initials: K
authors.lastname: Allison
authors.forename: Irene
authors.initials: I
authors.lastname: Wapnir
mesh_terms: D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D057234:Preoperative Period; D021701:Sentinel Lymph Node Biopsy; D013653:Tattooing / Q000379:methods; D016896:Treatment Outcome