الفهرس 
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Abstract
Staging strategy for node-positive axilla (cN+) that achieve complete clinical response (ycN0) after NACT is still a subject of controversy. SLNB has been debated to have high false negative rate. Targeted Axillary Dissection (TAD) is a technique where positive node(s) are marked pre-NACT followed by excision of the marked node along with sentinel node for accurate staging. This study evaluated the feasibility of axillary lymph node carbon tattooing is NACT setting. This is a prospective single-arm feasibility study where 20 breast cancer patients from a single center were recruited. Patients with clinically suspicious axillary nodes planned for NACT had fine needle biopsy from the suspicious node with simultaneous injection of carbon suspension. After NACT, axilla-negative patients on repeat ultrasound had TAD where Targeted Lymph Node (TLN) was excised along the Sentinel Lymph Node (SLN). Axillary Lymph Node Dissection (ALND) was performed if any TLN/SLN was proved pathologically involved. Total of 20 patients were carbon-labelled before systemic therapy. Eleven patients were included in the final analysis, while nine patients were excluded (six remained node-positive post-NACT, one with progressive disease, one with failed SLN and one patient withdraw). Median age was 39 years, median tumor size pre-NACT was 30 mm, whilst post-NACT was 11 mm. Carbon-tattooed lymph node was located in 18/20 patients (90%). In patients who had TAD, the TLN and SLN were the same node in 9/11 patients (82%), and in this group, 7/11 patients had positive TAD and proceeded to ALND with four patients showing further positive nodes. Targeted LN was not the sentinel node in two patients; in both cases, all nodes were negative. Median duration between carbon labelling and surgery was 5 months. Carbon tattooing of axillary lymph nodes seems to provide a safe, cheap and reliable alternative to marker clips without the need for image-guidance to locate the marked node which provide an excellent alternative for low resource countries and with the advantage of durable tissue staining. Larger samples and long term follow up are needed to confirm these finding, establish safety profile and assess the effect on false-negative rates and pathologic interpretation.