Carbon Dye Tattooing of Biopsied Axillary Node in Breast Cancer
Carbon Dye Tattooing of Biopsied Axillary Node in Breast Cancer
The primary aim of this prospective, multicentre study is to determine whether the involved
 node can be marked using black carbon dye and successfully identified at the time of surgery.
 The secondary aims are to determine the concordance between the tattooed node and sentinel
 node, migration of black dye into other nodes, and false-negative rate of tattooed node (in
 patients undergoing ALND after NACT).
Pretreatment evaluation of axillary lymph nodes and marking of biopsied nodes in patients
 with newly diagnosed breast cancer is becoming routine practice. Tagging of biopsied axillary
 lymph nodes with metal markers, similar to what is done for suspicious breast lesions, is
 being adopted in clinical practice. The need to mark a positive axillary lymph node becomes
 especially relevant in cases where neoadjuvant chemotherapy (NACT) is anticipated so that
 these nodes may be identified at the time of surgery. Measures that improve both the accuracy
 of nodal evaluation after NACT and the ability to assess treatment response are desirable in
 order to tailor therapies for breast cancer treatment. The investigators sought to test
 tattooing of biopsied axillary lymph nodes with a sterile black carbon suspension (Spot dye).
 The concept is based on the experience in the gastrointestinal tract wherein tattooing is
 widely used for marking lesions or tumours biopsied during endoscopy. India ink tattoos of
 colonic lesions remain identifiable over a long period of time. Spot is routinely used in the
 UK for tattooing gastrointestinal tract lesions and is used to mark the axillary lymph nodes
 in breast cancer by some centres in the US and Europe. The intraoperative success of
 identifying tattooed axillary lymph nodes and their concordance to sentinel nodes will be
 determined.
Inclusion Criteria:

 -  Age ≥ 18

 -  Male or female

 -  Patients scheduled to undergo routine fine needle aspiration (FNA) or core biopsy of
 abnormal axillary lymph node

 -  Invasive breast cancer

 -  Written informed consent for the study

 Exclusion Criteria:

 -  Not undergoing surgery or unfit for surgery