Marking Techniques for Target Lymph Nodes in Node-Positive Breast Cancer Treated With Neoadjuvant Therapy in the AXSANA/EUBREAST-03/AGO-B-053 Study
Abstract
PURPOSE Surgical axillary staging in patients with node-positive breast cancer (BC) who converted to clinical node negativity through neoadjuvant chemotherapy (NACT) has changed significantly in recent years. Targeted axillary dissection (TAD) and target lymph node (TLN) biopsy (TLNB) became increasingly popular. However, data comparing marking techniques for the TLN are limited. Here, we evaluate marking techniques in the largest prospective cohort worldwide. MATERIALS AND METHODS Among patients from the ongoing prospective multicenter AXSANA (EUBREAST-03) study who received TLN marking and TAD/TLNB, we evaluated different marking methods with respect to detection and removal rates and clinical performance. RESULTS Until January 6, 2025, 6,129 patients from 26 countries were enrolled. Of these patients, 2,596 had ≥1 TLN marked before NACT and completed surgery; 13.3% of the patients had ≥4 suspicious nodes at diagnosis. Pre-NACT TLN marking used a clip in 2,003 patients (77.2%), magnetic seed in 287 (11.1%), carbon ink in 192 (7.4%), radar marker in 119 (4.6%), radioactive seed in 18 (0.7%), radiofrequency identification device (RFID) in 12 (0.5%), or other methods in two (0.1%). One TLN was marked in 2,427 patients (93.5%), two TLNs in 138 (5.3%), and ≥3 in 27 patients (1%). Targeted removal of the TLN was planned in 2,100 patients (80.9%; TAD in 2,076 [80.0%] and TLNB in 24 [0.9%]). The TLN was detected and removed by TAD/TLNB in 1,915 patients (91.2%). TLN detection rate was the highest in patients whose TLNs were marked pre-NACT with markers suitable for probe-guided detection (96.6%; radioactive seed: 100%, magnetic seed: 96.9%, radar marker: 96.1%, RFID: 90%), followed by carbon ink (94.9%) and clip (89.6%; P < .001). CONCLUSION This large prospective analysis of patients with initially clinically node-positive BC receiving NACT demonstrates that probe-guided detection markers used to mark metastatic nodes before NACT provide superior detection rates.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (52)
Maggie Banys-Paluchowski
Steffi Hartmann
Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany
Jana de Boniface
Department of Surgery, Capio St. Göran’s Hospital, Stockholm
Oreste D. Gentilini
Breast Surgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
Nina Ditsch
Elmar Stickeler
University Hospital Aachen, Aachen, Germany
Guldeniz Karadeniz Cakmak
Zonguldak BEUN The School of Medicine, Breast and Endocrine Unit, General Surgery Department, Kozlu/Zonguldak, Turkey
Michael Hauptmann
Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
Jennifer Schroth
Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
Marc Thill
Department of Gynecology and Gynecologic Oncology, Agaplesion Markus Hospital, Frankfurt am Main, Germany
Rosa Di Micco
Breast Surgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
Markus Hahn
Department of Gynecology and Obstretrics, University Hospital Tübingen, Tübingen, Germany
Dawid Murawa
General Surgery and Surgical Oncology Department, Collegium Medicum, University in Zielona Gora, Zielona Gora, Poland
Isabel T. Rubio
Breast Surgical Unit, Clínica Universidad de Navarra, Madrid, Spain
David Pinto
Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisboa, Portugal
Michalis Kontos
Department of Surgery, University of Athens Laiko Hospital, Athens, Greece
Laura Niinikoski
Maria Luisa Gasparri
Helidon Nina
Department of Surgery, Oncology Hospital, Tirana, Albania
Lia P. Rebaza
Breast Surgery, Oncosalud, Lima, Peru
Sarah Fröhlich
Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany
Esther Schmidt
Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany
Kristina Wihlfahrt
Practice for Gynecology and Obstetrics Wihlfahrt, Kiel, Germany
Tomasz Berger
Department of Gynecology and Obstetrics, Müritz-Klinikum Waren, Waren, Germany
Timo Basali
Department of Gynecology, Hospital Stuttgart, Stuttgart, Germany
Franziska Ruf
Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lübeck, Germany
Angelika Rief
Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
Eduard-Alexandru Bonci
Florentia Peintinger
Department of Gynecology and Obstetrics, Müritz-Klinikum Waren, Waren, Germany
Ellen Schlichting
Department of Oncology, Oslo University Hospital, Norway
Hagigat Valiyeva Qanimat
Oncologic Clinic of Azerbaijan Medical University, Baku, Azerbaijan
Marian Vanhoeij
Universitair Ziekenhuis Brussel, Brussel, Belgium
Geeta Kadayaprath
MAX Hospital, Patparganj, New Delhi, India
Lukas Dostalek
Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
Ashutosh Kothari
Guy's & St. Thomas NHS Trust, Gillingham, United Kingdom
Andraz Perhavec
Institute of Oncology Ljubljana, Ljubljana, Slovenia
Tsvetomir Ivanov
Douglas Zippel
Surgical Oncology Unit Chaim Sheba Medical Centre, Ramat Gan, Israel
Beata Adamczyk
Breast Cancer Unit, Greater Poland Cancer Centre, Poznan, Poland
Mauro Porpiglia
Breast Unit S. Anna Hospital, Turin, Italy
Günay M. Gürleyik
Department of General Surgery, Istanbul Haydarpasa Numune Training and Research Hospital, University of Health Sciences Turkey, İstanbul, Turkey
Michael Untch
From the National Surgical Adjuvant Breast and Bowel Project (NSABP) Foundation (C.E.G., E.P.M., N.W., P.R., I.L.W., A.M.B.) and University of Pittsburgh School of Medicine–UPMC Hillman Cancer Center (C.E.G., N.W., P.R., A.M.B.) — both in Pittsburgh; AGO-B and Helios Klinikum Berlin–Buch, Berlin (M.U.), the National Center for Tumor Diseases, Heidelberg University Hospital, and German Cancer Research Center, Heidelberg (A.S.), Evangelische Kliniken Gelsenkirchen, Gelsenkirchen (H.H.F.), Arbeitsgemeinschaft Gynäkologische Onkologie–Breast and Sana Klinikum Offenbach, Offenbach (C.J.), the Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen–EMN, Friedrich–Alexander University Erlangen–Nuremberg, Erlangen (P.A.F.), German Breast Group, Neu-Isenburg (P.W., S.L.), and the Center for Hematology and Oncology Bethanien, Goethe University, Frankfurt (S.L.) — all in Germany; National Taiwan University Hospital and National Taiwan University College of Medicine,...
Michael P. Lux
Department of Gynecology and Obstetrics, Frauenklinik St Louise, Paderborn, Frauenklinik St Josefs-Krankenhaus, Salzkotten, St Vincenz Kliniken, Paderborn, Germany
Katharina Jursik
EUBREAST e.V., Esslingen, Germany
Hans-Christian Kolberg
Toralf Reimer
Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
Nikolas Tauber
Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
Achim Rody
Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
Zoltan Matrai
Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
Natalia Krawczyk
Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
Sarun Thongvitokomarn
Queen Sirikit Centre for Breast Cancer, Bangkok, Thailand
Thorsten Kühn
Hospital Esslingen, Esslingen, Germany