This pilot clinical trial studies how well selective image-guided surgery works in determining the accuracy of removing cancer that has spread to the lymph nodes in patients with breast cancer. Selective image-guided surgery involves placing electromagnetic reflectors in the metastatic lymph nodes before surgery and then using a special device during surgery to identify the reflectors, which may help doctors accurately find which lymph nodes should be removed.
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT03281720.
PRIMARY OBJECTIVES:
I. To determine the false-negative rate (FNR) of targeted axillary dissection (TAD) (using a marker clip device node localization) after neoadjuvant chemotherapy in patients presenting with node positive disease as determined by fine needle aspiration (FNA) or core needle biopsy (CNB).
SECONDARY OBJECTIVES:
I. To record the pathologic complete response rate (pCR, absence of residual metastases) of the previously percutaneously marked abnormal axillary node(s) following preoperative chemotherapy.
II. To calculate the percentage of lymph nodes removed with axillary lymph node dissection (ALND) not identified by TAD that harbor residual metastasis.
III. To determine the success rate of preoperative localization with the Savi Scout reflector technology for surgical excision of pathologically documented axillary node metastases during routine axillary node dissection following preoperative chemotherapy.
IV. To determine the FNR and overall accuracy of targeted axillary ultrasound in identifying axillary metastasis before and after preoperative chemotherapy.
V. To determine the ultrasound feature(s) with the highest positive predictive value for axillary metastasis and most common feature(s) leading to recommendation for biopsy.
VI. To determine the locoregional recurrence rate in the subject population.
VII. To determine the overall survival rate in the subject population.
OUTLINE:
Patients undergo ultrasound imaging and placement of Savi Scout electromagnetic reflectors in metastatic clipped axillary lymph nodes no more than 30 days before surgery. Patients then undergo surgical removal of Savi Scout marked lymph nodes as well as standard of care ALND and either segmental mastectomy or total mastectomy with or without reconstruction.
After completion of study, patients are followed up at 1-2 weeks.
Trial PhaseNo phase specified
Trial Typetreatment
Lead OrganizationUNC Lineberger Comprehensive Cancer Center
Principal InvestigatorKristalyn K Gallagher