Three mastologists from the same family presented a video on “directed axillary dissection” using charcoal as a marker at the National Congress of Surgery. The technique allows only the affected lymph node negative with chemotherapy to be removed. “We want to offer the possibility of applying this technique safely in our hospitals and places where there is oncology training in breast cancer,” said Lilian Navarro
Laura Clisanchez | Mail of the Caroni
Guayanese surgeons and mastologists Lilian Navarro, José Navarro and Bexaida Navarro, from the Family Mastology UnitThey won the “Dr. Miguel Pérez Carreño» of the Venezuelan Society of Surgery at the National Congress of Surgery 2022 for promoting Directed Axillary Dissection using charcoal as a marker in patients with breast cancer with metastasis in the axilla. An efficient and low-cost method.
This procedure consists of removing only the affected lymph node(s) from the armpit, instead of dissecting all the lymph nodes in the area. The condition for applying this technique is that the patient has received chemotherapy before surgery (neoadjuvant chemotherapy) and that the metastatic node, consequently, has been free of cancer cells. This happens in 40% to 60% of cases.
Why avoid complete axillary dissection in these particular cases? Because in this way chronic and permanent complications such as lymphedema are prevented, which is the painful and permanent swelling of, in this case, an arm.
“For a long time it was thought that mastectomy was the ideal for all patients. Then it was found that by removing the tumor and conserving the breast -conserving breast surgery-, the tumor is removed from the woman with a margin of healthy tissue, the axillary nodes are studied through a procedure called sentinel node biopsy and it is not dissect all the nodes in the armpit, because the dissection of the nodes brings consequences that not all patients have to go through,” explained Lilian Navarro, a mastologist surgeon, in an interview with Mail of the Caroni.
To remove the node that is no longer cancerous, the periphery of the node must be punctured with 1 cc of charcoal. Then we proceed to identify the node now stained black, to remove it together with the sentinel node.
This June 18 we were invited to participate in the Web Seminar of the @svmastologia
We share our experience in directed axillary dissection using charcoal as a marker in breast cancer patients treated with neoadjuvant chemotherapy. pic.twitter.com/FrBQPeapsR— Family Mastology Unit (@mastofamilia) June 20, 2022
The sentinel node is done with the injection of patent blue, a liquid that marks or evaluates the sentinel node(s), which is the first node where cancer cells from the primary tumor are most likely to spread. The pathologist determines whether the marked nodes have metastases or are negative. This procedure is called directed axillary dissection and has a low false-negative rate.
There are several ways to mark the nodes when performing a directed axillary dissection, such as marking with titanium, steel or hydrogel clips, but these markers are expensive and difficult to access for most hospitals and clinics in the country, says the specialist .
Navarro explained that, although charcoal marking is not a new method, but widely used in other countries, it is not usually used in Venezuela despite being low cost.
As a consequence, patients who, after receiving chemotherapy, achieve a complete pathological response of the tumor must still undergo complete axillary dissection and face complications that, in this specific case, are avoidable.
«We want to offer the possibility of applying this technique safely in our hospitals and places where there is oncology training in breast cancer.to benefit patients and not perform procedures as aggressive as axillary dissection, in the specific case of breast cancer with lymph node metastases that become negative with neoadjuvant chemotherapy”, explained Navarro.
Navarro maintains that, internationally, surgical treatment for breast cancer has evolved to be less aggressive, and to be applied according to the specific biology of each tumor, that is, how aggressive is its ability to grow, how fast and if it can spread. to other tissues.
“It will not depend on how aggressive the treatment is. You can remove the entire breast from the patient (mastectomy), you can remove the lymph nodes (axillary dissection), you can disarticulate an arm and the patient could still die from cancer if the biology of the tumor is aggressive or if the diagnosis is late”, pointed out.
“In breast cancer surgery, less is more”
“For a long time it was thought that when a patient had breast cancer with metastases in the axillary nodes, she had to have an axillary dissection, it was a rule. But science has advanced and today we want to be less aggressive in order to avoid a complication for the patient, because the information provided by the state of the armpit is a tumor staging tool, but not a curative one. Not because you remove the nodes are you going to cure that patient of what her prognosis is going to be in 10, 15 or 20 years, but it is going to give you information about the tumor and about the state of the armpit, “he said. the specialist.
Navarro maintains that, in Venezuela, surgical treatment for breast cancer must be individualized. That is, each case must be handled in a specific, personalized way and with a multidisciplinary team.
“This is something very specific, not all patients are going to undergo neoadjuvant chemotherapy and not all patients who receive neoadjuvant chemotherapy are guaranteed that the tumor will become negative or decrease in size. There are locally advanced tumors, others more operable and others will require mastectomy. The concepts are still valid: there are patients who will need an axillary dissection, but there are other patients who will benefit from this type of procedure and that is what we want », she emphasized.
The Family Mastology Unit is a private clinical unit located in Ciudad Guayana. He has a 23-year history dedicated to the surgical treatment of breast cancer in an interdisciplinary manner.
It was founded by Dr. José Navarro, surgeon and mastologist; who, in addition, is a pioneer in breast interventional procedures, ultrasound-guided biopsies, oncoplastic breast surgery and reconstructive surgery in Ciudad Guayana.
His daughter, Lilian Navarro, a 33-year-old mastologist surgeon, is an active member of the Venezuelan Society of Surgery, and an associate member of the Venezuelan Society of Mastology. Together with her sister and her father, she has co-written scientific articles published in the Venezuelan Journal of Surgery and Oncology.
Glossary of terms
patent blue: Fast, accurate and low-cost technique to identify lymphatic metastases in breast cancer.
Axillary dissection: Surgery to remove the lymph nodes found in the armpit region.
sentinel node: It is the first lymph node where cancer cells from the primary tumor are most likely to spread. Sometimes there is more than one sentinel lymph node.
lymphedema: A condition in which an extra amount of lymph accumulates in the tissues and causes swelling. It can occur in an arm or leg if the lymphatic vessels are blocked, damaged, or surgically removed.
Metastasis: The spread of cancer cells from the place where the cancer first formed to another part of the body.
neoadjuvant chemotherapy: Treatment given as a first step to reduce the size of the tumor before the main treatment, which usually consists of surgery.
complete pathologic response: Absence of all signs of cancer in tissue samples obtained during surgery or a biopsy after treatment with radiation or chemotherapy.
Source: US National Cancer Institute
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