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Osteopathic Manipulative Medicine Enhances Tracer Uptake and Sentinel Node Mapping During Breast-Conserving Surgery: A Randomized Controlled Trial
Stejskal, I. [1]
Clutts, B. [1]
Ribar, J. [2]
Erdrich, J. [1]
Ditillo, M. [1]
Baatz, M. [1]
Butts, L. [1]
Verdugo, C. [1]
Yao, G. [1]
Hsu, C.H. [1]
Abdelsattar, J. [1]
Foster, N. [6]

Journal: Annals of Surgical Oncology Date: 2026/08, 33(S2):Pages: 727–729. doi: Subito , type of study: randomized controlled trial

Full text    (https://link.springer.com/article/10.1245/s10434-026-20020-9)

Keywords:

breast cancer [18]
conference abstract [126]
female [648]
lymph node mapping [1]
lymphatic system [58]
OMT [3896]
osteopathic manipulative treatment [3917]
randomized controlled trial [936]
surgical care [69]
women [602]

Abstract:

Background/Objective: Accurate sentinel lymph node (SLN) mapping is essential for successful breast cancer staging and treatment planning, yet variable tracer uptake persists despite advances in dual-tracer protocols. Osteopathic Manipulative Medicine (OMM) is a form of neuromusculoskeletal treatment that helps to restore the body's functional state and optimize fascial movement and lymphatic flow. Our study hypothesized that targeted OMM performed prior to breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB) would increase radiotracer and blue dye uptake and ultimately optimize SLN identification. Methods: Following IRB approval, this ongoing single-institution feasibility randomized controlled trial (target n = 30) was conducted accruing women undergoing BCS with SLNB with no prior breast or axillary surgery. Patients were randomized to either a control or intervention group with 3 breast surgeons blinded to group allocation. Following intraoperative injection of both 3cc of isosulfan blue and 0.9–1.1 mCi of Tc-99m sulfur colloid into the breast, the control group received nine minutes of standard breast massage (SBM), while the intervention group received five minutes of SBM followed by four minutes of OMM performed by the first author. These OMM techniques included opening the thoracic inlet, pectoral traction, and thoracic and axillary lymphatic pumps. Primary endpoints included time to first SLN retrieval, percentage of blue dye uptake, and average SLN radiotracer counts. The percentage of blue dye uptake was determined visually by the operating surgeon. A node was labeled as 25% blue if it had a blue channel and/or minimal blue coloration of the node, 50% blue if it was a moderately/partially blue node, 75% blue if it was a mostly blue node, and 100% blue if it was a completely blue node. Multivariable logistic and multinomial regression models were used to assess group differences, controlling for age, race, body mass index, and tumor subtype. This report summarizes the interim analysis of 25 completed cases. Results: A total of 25 patients were enrolled, with 12 in the control group (SBM) and 13 in the intervention group (OMM+SBM). Baseline characteristics including BMI (28.4 vs 30.8, p=0.5) and tumor size (1.25±0.71 cm vs 1.55±0.72 cm, p=0.3) were similar between the OMM+SBM and SBM groups, respectively. Patients receiving OMM+SBM had a higher statistically significant rate of 100% blue dye uptake in SLNs compared to those receiving SBM (46% [n=6] vs. 8.3% [n=1], p=0.009) (Fig.1). OMM+SBM yielded a higher total number of blue-identified SLNs compared to SBM (22 vs 14 total). Mean SLN radiotracer counts were higher in the OMM+SBM group compared to the SBM group (9,408 ± 13,948 counts/10sec vs. 6,566 ± 6,489 counts/10sec, p=0.054). Non-blue SLNs were less frequently removed in OMM+SBM patients compared to SBM patients (31% [n=4] vs 50% [n=6], p=0.066) (Fig.1). Additionally, one patient failed to map both tracers, and this occurred in the SBM only group. Time to first SLN retrieval was shorter in the group receiving OMM+SBM compared to SBM (73 ± 19 min vs 84 ± 25 min, p=0.8). Conclusion: Our study shows that the addition of osteopathic manipulation prior to sentinel lymph node biopsy in breast-conserving surgery was associated with significantly increased rates of complete (100%) blue dye uptake, decreased number of patients with non-blue nodes removed, and a trend approaching significance towards higher radiotracer uptake per node. We postulate that these effects may result from OMM decreasing fascial restrictive barriers of the chest wall and axilla and improving forward flow of lymph fluid. Our initial results suggest that these manipulation techniques may lead to enhanced lymphatic flow and tracer migration, particularly for isosulfan blue dye, and in doing so, result in improved accuracy and ease of axillary SLN identification. The sample size is small for this interim analysis, and validation in larger cohorts is needed to confirm reproducibility; however, this technique holds promise for providing an inexpensive and effective way to improve SLN mapping in breast cancer patients.

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