Internal Mammary Sentinel Lymph Node Biopsy in Early Breast Cancer Patients With Clinically Axillary Node -Negative

NCT ID: NCT01642511

Last Updated: 2018-04-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

407 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-01-31

Study Completion Date

2015-03-31

Brief Summary

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In addition to the axillary lymph node, the internal mammary lymph node (IMLN) chain is also the first-echelon nodal drainage site for metastasis and provides important prognostic information in breast cancer patients. The internal mammary sentinel lymph node biopsy (IM-SLNB) provides a less invasive method of assessing the IMLN than surgical dissection. But the low visualization rate of IMSLN has been a restriction of IM-SLNB. This clinical trial is carried out to improve the visualization rate of IMSLN with modified techniques: (1) The radiotracer is injected intraparenchymally into 2\~4 quadrants of breast. (2) The radiotracer is injected in a high volume. (3) The radiotracer should be injected under ultrasonographic guidance.

Detailed Description

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OBJECTIVES:

* Compare the visualization rate of internal mammary sentinel lymph node in breast cancer patients with different injection technologies.
* Evaluate the metastasis rate of internal mammary sentinel lymph nodes in patients with clinically axillary node -negative in these patients.
* Evaluate the risk factors for internal mammary sentinel lymph node metastasis
* Evaluate the success rate and the safety of internal mammary sentinel lymph node biopsy.
* Draw the learning curve of internal mammary sentinel lymph node biopsy.

OUTLINE:

3\~18 hours before surgery, 99mTc-labeled sulfur colloid was injected under ultrasonographic guidance in different patterns and injection methods were classified according to the number of injection quadrants. Subsequently, lymphoscintigraphy was performed 0.5\~1.0 hour before surgery. During surgery, the sentinel lymph nodes (axillary or internal mammary) were identified by combining the use of intraoperative gamma detector and blue dye. The sentinel lymph nodes (axillary or internal mammary) were analyzed by hematoxylin-eosin staining and immunohistochemistry for future therapy planning.

Conditions

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Breast Cancer

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Control Group

conventional technique: 99mTc-labeled Sulfur Colloid was injected into the tumor quadrant 3-24 hours before surgery, lymphoscintigraphy was performed 30min before surgery. Four milliliters of methylthioninium was injected subcutaneously above the primary tumor or around the biopsy cavity 10 min before surgery. Axillary sentinel lymph node biopsy and Internal mammary sentinel lymph node biopsy was performed during surgery. Axillary lymph node dissection was performed if ASLN was positive.

Group Type ACTIVE_COMPARATOR

99mTc-labeled Sulfur Colloid

Intervention Type RADIATION

Control Group: Each patient received the 1 intraparenchymal injection of 99mTc-SC (0.5\~1.0 mCi/0.5mL) in the tumor quadrant. Study Group: Two syringes of 0.25\~0.5 mCi 99mTc-SC in 0.2\~1.0 mL volume were injected intraparenchymally into 2 quadrants of breast, at the 6 and 12 o'clock positions.

Axillary Sentinel Lymph Node Biopsy

Intervention Type PROCEDURE

Sentinel lymph node biopsy

Methylthioninium

Intervention Type DRUG

Four milliliters of methylthioninium was injected subcutaneously above the primary tumor or around the biopsy cavity 10 min before surgery

Lymphoscintigraphy

Intervention Type DEVICE

Sequential anterior and lateral gamma imaging was performed with patients lying prone and by injection side just before surgery using a digital gamma camera computer system (Toshiba GCA-901A/HG).

Axillary Lymph Node Dissection

Intervention Type PROCEDURE

ALND was performed consequently if axillary SLNB was failure or axillary SLNs were positive.

Internal Mammary Sentinel Lymph Node Biopsy

Intervention Type PROCEDURE

Internal mammary sentinel lymph node biopsy

Study Group

modified technique: 99mTc-labeled Sulfur Colloid was injected into 2 quadrants of the breast 3-24 hours before surgery, lymphoscintigraphy was performed 30min before surgery. Four milliliters of methylthioninium was injected subcutaneously above the primary tumor or around the biopsy cavity 10 min before surgery. Axillary sentinel lymph node biopsy and Internal mammary sentinel lymph node biopsy was performed during surgery. Axillary lymph node dissection was performed if ASLN was positive.

Group Type EXPERIMENTAL

Axillary Sentinel Lymph Node Biopsy

Intervention Type PROCEDURE

Sentinel lymph node biopsy

Methylthioninium

Intervention Type DRUG

Four milliliters of methylthioninium was injected subcutaneously above the primary tumor or around the biopsy cavity 10 min before surgery

Lymphoscintigraphy

Intervention Type DEVICE

Sequential anterior and lateral gamma imaging was performed with patients lying prone and by injection side just before surgery using a digital gamma camera computer system (Toshiba GCA-901A/HG).

Axillary Lymph Node Dissection

Intervention Type PROCEDURE

ALND was performed consequently if axillary SLNB was failure or axillary SLNs were positive.

Internal Mammary Sentinel Lymph Node Biopsy

Intervention Type PROCEDURE

Internal mammary sentinel lymph node biopsy

Interventions

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99mTc-labeled Sulfur Colloid

Control Group: Each patient received the 1 intraparenchymal injection of 99mTc-SC (0.5\~1.0 mCi/0.5mL) in the tumor quadrant. Study Group: Two syringes of 0.25\~0.5 mCi 99mTc-SC in 0.2\~1.0 mL volume were injected intraparenchymally into 2 quadrants of breast, at the 6 and 12 o'clock positions.

Intervention Type RADIATION

Axillary Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy

Intervention Type PROCEDURE

Methylthioninium

Four milliliters of methylthioninium was injected subcutaneously above the primary tumor or around the biopsy cavity 10 min before surgery

Intervention Type DRUG

Lymphoscintigraphy

Sequential anterior and lateral gamma imaging was performed with patients lying prone and by injection side just before surgery using a digital gamma camera computer system (Toshiba GCA-901A/HG).

Intervention Type DEVICE

Axillary Lymph Node Dissection

ALND was performed consequently if axillary SLNB was failure or axillary SLNs were positive.

Intervention Type PROCEDURE

Internal Mammary Sentinel Lymph Node Biopsy

Internal mammary sentinel lymph node biopsy

Intervention Type PROCEDURE

Other Intervention Names

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99mTc-SC SLNB LSG ALND IM-SLNB

Eligibility Criteria

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Inclusion Criteria

* primary breast cancer
* clinically axilla-negative

Exclusion Criteria

* enlarged internal mammary nodes by imaging
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Shandong Cancer Hospital and Institute

OTHER

Sponsor Role lead

Responsible Party

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Yongsheng Wang

Director, Head of Breast Cancer Center, Principal Investigator, Clinical Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Yong-sheng Wang, MD

Role: STUDY_CHAIR

Shandong Cancer Hospital and Institute

Peng-fei Qiu, MD

Role: PRINCIPAL_INVESTIGATOR

Shandong Cancer Hospital and Institute

Locations

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Shandong Cancer Hospital

Jinan, Shandong, China

Site Status

Countries

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China

References

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Qiu PF, Liu JJ, Liu YB, Yang GR, Sun X, Wang YS. A modified technology could significantly improve the visualization rate of the internal mammary sentinel lymph nodes in breast cancer patients. Breast Cancer Res Treat. 2012 Nov;136(1):319-21. doi: 10.1007/s10549-012-2203-5. Epub 2012 Sep 6. No abstract available.

Reference Type RESULT
PMID: 22956005 (View on PubMed)

Qiu P, Zhao R, Cong B, Yang G, Liu Y, Chen P, Sun X, Wang C, Wang Y. [Internal mammary sentinel lymph node biopsy in breast cancer: accurate staging and individualized treatment]. Zhonghua Zhong Liu Za Zhi. 2016 Jan;38(1):42-7. doi: 10.3760/cma.j.issn.0253-3766.2016.01.009. Chinese.

Reference Type DERIVED
PMID: 26796806 (View on PubMed)

Other Identifiers

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IMSN001

Identifier Type: -

Identifier Source: org_study_id

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