Guidelines for node marking:
Node marking is recommended for NodeSMART but not mandatory. Sites are advised to follow the the best practice node marking standards used in the ongoing ATNEC breast cancer trial. At least three nodes should be removed to allow adequate assessment of nodal tumour burden.
Timing:
The node may be marked at the time of needle biopsy or at a separate visit.
Technique:
Node may be marked using any technique e.g. clip or coil (with or without skin mark), black dye, magnetic seeds or reflector.
Black dye node marking:
Inject 0.2-0.4 ml of black dye into the cortex of the node Do not inject around the node or into the needle tract
If the marked node is not found or if multiple black nodes are identified the surgeon may stop once a total of four nodes have been removed
Single vs multiple node marking:
It is not necessary to mark more than one node, even if multiple nodes are biopsied or appear malignant. The most abnormal-appearing node should be marked.
