Breast tattoos for planning surgery following neoadjuvant chemotherapy

Background Although neoadjuvant chemotherapy is increasingly used for breast cancer, if a patient has a complete clinical response, it is often difficult for the surgeon to know exactly where and how much breast tissue to remove. Methods A method is described where the edges of the tumor are tattooed prior to chemotherapy, allowing all tissue initially involved with tumor to be resected following the chemotherapy. Results Thirty-four cases have been tattooed prior to neoadjuvant chemotherapy, and the clinical and pathological complete response rates were 56% and 22%, respectively. The tattoos allowed very accurate localization of the residual tumor location and extent. Of the 22 patients who have so far undergone lumpectomy, 77% had residual pathologic evidence of tumor, but the margins were negative in 91% at the first operation. Only 2 patients had to undergo a mastectomy because of persistently positive margins. Conclusions The technique of breast tattooing is a simple and practical method to guide the extent of breast surgery following neoadjuvant chemotherapy. In contrast to placement of clips, the technique does not require needle localization, and it allows accurate determination of the initial tumor size and margins.