A study of 224 patients demonstrated that using tattoo ink to mark suspicious lymph nodes before breast cancer surgery achieved a 94% success rate for surgical localization.
Conducted between September 2018 and January 2023 at a multisite academic institution, the study evaluated a novel technique in which radiologists injected carbon ink into previously biopsied lymph nodes under ultrasound guidance. The method aimed to facilitate targeted axillary dissection by enabling surgeons to visualize the nodes intraoperatively. The median patient age was 55 years.
Of the 224 procedures, 223 (99.6%) radiologist-performed ink injections were successful, with no reported complications. Surgeons localized the target node intraoperatively in 94% (211/224) of cases. The ink was visualized directly within the node in 206 patients and around the node in five cases. Nearly all successful procedures occurred within seven days of injection, according to research published in the American Journal of Roentgenology.
The success rate remained at 93% (145/156) among patients who received neoadjuvant chemotherapy. Radiologists with experience in 20 cases or more achieved a 97% success rate compared to 90% for less experienced practitioners (P = 0.04). Similarly, surgeons with 50 cases or more reached a 98% success rate versus 90% for those with fewer procedures (P = 0.01).
In 13% of cases where both the tattoo technique and sentinel lymph node biopsy (SLNB) were performed successfully, the marked node was not identified by the SLNB alone. This rate is lower than the 55% reported in prior studies, potentially due to most procedures occurring within 7 days of ink injection.
Primary breast cancer accounted for 93% of cases, with other pathologies including metastatic ovarian cancer (2), lung cancer (2), melanoma (2), and chronic lymphocytic leukemia (1). Researchers noted that tattoo ink localization is safe, affordable, and an accessible alternative to standard guidewire and non-wire localization methods.
The authors noted limitations, including the single-center setting, retrospective data collection, and limited data for cases with a longer interval (over 7 days) between injection and surgery. Further research is recommended to validate findings in broader clinical settings.
The authors declared having no competing interests.
