Ultrasound-guided blue dye localization of a clipped axillary lymph node after neoadjuvant chemotherapy in breast cancer a prospective feasibility study and critical review of axillary localization techniques.
[BACKGROUND] In patients with biopsy-proven node-positive breast cancer treated with neoadjuvant chemotherapy (NAC), sentinel lymph node biopsy (SLNB) alone is associated with elevated false-negative
APA
El Aoud I, Mesdag V, et al. (2026). Ultrasound-guided blue dye localization of a clipped axillary lymph node after neoadjuvant chemotherapy in breast cancer a prospective feasibility study and critical review of axillary localization techniques.. Surgical oncology, 66, 102432. https://doi.org/10.1016/j.suronc.2026.102432
MLA
El Aoud I, et al.. "Ultrasound-guided blue dye localization of a clipped axillary lymph node after neoadjuvant chemotherapy in breast cancer a prospective feasibility study and critical review of axillary localization techniques.." Surgical oncology, vol. 66, 2026, pp. 102432.
PMID
42035610
Abstract
[BACKGROUND] In patients with biopsy-proven node-positive breast cancer treated with neoadjuvant chemotherapy (NAC), sentinel lymph node biopsy (SLNB) alone is associated with elevated false-negative rates, as demonstrated in several prospective multicenter trials-. Targeted axillary dissection (TAD), combining excision of the clipped metastatic lymph node with SLNB, has been shown to significantly reduce false-negative rates and is now incorporated into contemporary guidelines,,. Therefore, selecting the most appropriate localization technique is essential to ensure accurate identification and removal of pathologic axillary lymph nodes. Furthermore, the National Comprehensive Cancer Network (NCCN) guidelines also acknowledge the potential role of targeted axillary techniques outside the neoadjuvant setting, particularly in patients eligible for sentinel lymph node biopsy who present with a limited number of biopsy-proven positive axillary lymph nodes.
[PURPOSE] To evaluate the feasibility of ultrasound-guided blue dye injection for localization of a clipped axillary lymph node after NAC and to position this technique within the spectrum of currently available axillary localization methods.
[METHODS] This prospective single-center study included patients with invasive breast cancer and biopsy-proven axillary metastasis treated with NAC in parallel with GANEA 3 study. Patients included in the present study were part of the GANEA3 cohort, in which the same axillary targeting protocol was applied. A metallic clip was placed in the metastatic lymph node at diagnosis. After NAC, the clipped node was targeted immediately before surgery using ultrasound-guided injection of 2-3 mL of blue dye. Surgical excision of the stained node was performed in association with SLNB and completion axillary lymph node dissection. Retrieval of the clipped node was confirmed using specimen radiography.
[RESULTS] Thirty-two patients were included. Localization failed in three cases due to non-visualization of the clip, absence of nodal tissue in the specimen, or omission of the localization procedure. The overall retrieval success rate was 90.6%. No interference with the SLNB procedure was observed.
[CONCLUSION] Ultrasound-guided blue dye localization of a clipped axillary lymph node after NAC is a feasible, low-cost, and radiation-free technique. It represents a pragmatic alternative for targeted axillary surgery, particularly in centers without access to radioactive or wireless localization devices. Larger comparative studies are required to define its diagnostic performance and oncologic impact.
[PURPOSE] To evaluate the feasibility of ultrasound-guided blue dye injection for localization of a clipped axillary lymph node after NAC and to position this technique within the spectrum of currently available axillary localization methods.
[METHODS] This prospective single-center study included patients with invasive breast cancer and biopsy-proven axillary metastasis treated with NAC in parallel with GANEA 3 study. Patients included in the present study were part of the GANEA3 cohort, in which the same axillary targeting protocol was applied. A metallic clip was placed in the metastatic lymph node at diagnosis. After NAC, the clipped node was targeted immediately before surgery using ultrasound-guided injection of 2-3 mL of blue dye. Surgical excision of the stained node was performed in association with SLNB and completion axillary lymph node dissection. Retrieval of the clipped node was confirmed using specimen radiography.
[RESULTS] Thirty-two patients were included. Localization failed in three cases due to non-visualization of the clip, absence of nodal tissue in the specimen, or omission of the localization procedure. The overall retrieval success rate was 90.6%. No interference with the SLNB procedure was observed.
[CONCLUSION] Ultrasound-guided blue dye localization of a clipped axillary lymph node after NAC is a feasible, low-cost, and radiation-free technique. It represents a pragmatic alternative for targeted axillary surgery, particularly in centers without access to radioactive or wireless localization devices. Larger comparative studies are required to define its diagnostic performance and oncologic impact.