Marking Techniques for Target Lymph Nodes in Node-Positive Breast Cancer Treated With Neoadjuvant Therapy in the AXSANA/EUBREAST-03/AGO-B-053 Study
Journal of Clinical Oncology, vol. 44, pp. 575–585
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.
Authors 51
-
University Hospital Schleswig-Holstein
Affiliation as printed
Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lübeck, Germany
-
Universitätsmedizin Rostock · University of Rostock
Affiliation as printed
Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany
-
Karolinska Institutet · Saint Göran Hospital
Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Department of Surgery, Breast Center, Capio St Göran's Hospital, Stockholm, Sweden
-
Vita-Salute San Raffaele University · IRCCS Ospedale San Raffaele
Affiliation as printed
Breast Surgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
Vita-Salute San Raffaele University, Milan, Italy
-
University of Augsburg · University Hospital Augsburg
Affiliation as printed
Bavarian Cancer Research Center (BZKF), Erlangen, Germany
Gynecology, Obstetrics and Senology, Faculty of Medicine, University of Augsburg, Breast Center, University Hospital Augsburg, CCC Augsburg, Augsburg, Germany
-
Affiliation as printed
Department of Gynecology and Obstetrics, University Hospital Aachen, Aachen, Germany
-
Zonguldak Bülent Ecevit University
Affiliation as printed
Breast and Endocrine Unit, General Surgery Department, Zonguldak BEUN The School of Medicine, Zonguldak, Turkey
-
Medizinische Hochschule Brandenburg Theodor Fontane
Affiliation as printed
Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
-
Medizinische Hochschule Brandenburg Theodor Fontane
Affiliation as printed
Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
-
Affiliation as printed
Department of Gynecology and Gynecological Oncology, Agaplesion Markus Hospital, Frankfurt, Germany
-
Vita-Salute San Raffaele University
Affiliation as printed
Vita-Salute San Raffaele University, Milan, Italy
-
Universitätsklinikum Tübingen · University of Tübingen
Affiliation as printed
Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
-
Affiliation as printed
Department of General Surgery and Surgical Oncology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
Department of General Surgery and Surgical Oncology, The Regional Hospital in Poznan—The Greater Poland Specialist Center, Poznan, Poland
-
Clinica Universidad de Navarra
Affiliation as printed
Breast Surgical Unit, Clínica Universidad de Navarra, Madrid, Spain
-
Affiliation as printed
Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisboa, Portugal
-
National and Kapodistrian University of Athens
Affiliation as printed
Department of Surgery, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
-
University of Helsinki · Helsinki University Hospital
Affiliation as printed
Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
-
Ospedale regionale di Lugano · Università della Svizzera italiana
Affiliation as printed
Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland
University of the Italian Switzerland (USI), Faculty of Biomedicine, Lugano, Switzerland
-
Affiliation as printed
Department of Surgery, Oncology Hospital, Tirana, Albania
-
Affiliation as printed
Breast Surgery, Oncosalud, Lima, Peru
-
Universitätsmedizin Rostock · University of Rostock
Affiliation as printed
Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany
-
Affiliation as printed
Practice for Gynecology and Obstetrics Wihlfahrt, Kiel, Germany
-
Affiliation as printed
Department of Gynecology and Obstetrics, Müritz-Klinikum Waren, Waren, Germany
-
Affiliation as printed
Department of Gynecology, Hospital Stuttgart, Stuttgart, Germany
-
University Hospital Schleswig-Holstein
Affiliation as printed
Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lübeck, Germany
-
Affiliation as printed
Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
-
Iuliu Hațieganu University of Medicine and Pharmacy · Institute of Oncology Prof. Dr. Ion Chiricuta
Affiliation as printed
Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
Department of Surgical Oncology, “Prof Dr Ion Chiricuță” Institute of Oncology, Cluj-Napoca, Romania
-
Affiliation as printed
Department of Gynecology and Obstetrics, Müritz-Klinikum Waren, Waren, Germany
Institute of Pathology, Medical University of Graz, Graz, Austria
-
Affiliation as printed
Department of Oncology, Oslo University Hospital, Norway
-
Affiliation as printed
Oncologic Clinic of Azerbaijan Medical University, Baku, Azerbaijan
-
Universitair Ziekenhuis Brussel
Affiliation as printed
Universitair Ziekenhuis Brussel, Brussel, Belgium
-
Affiliation as printed
MAX Hospital, Patparganj, New Delhi, India
-
Charles University · General University Hospital in Prague
Affiliation as printed
Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
-
Guy's and St Thomas' NHS Foundation Trust
Affiliation as printed
Guy's & St Thomas NHS Foundation Trust, London, United Kingdom
-
Institute of Oncology Ljubljana
Affiliation as printed
Institute of Oncology Ljubljana, Ljubljana, Slovenia
-
Affiliation as printed
Heart and Brain Hospital, Pleven, Bulgaria
-
Affiliation as printed
Surgical Oncology Unit Chaim Sheba Medical Centre, Ramat Gan, Israel
-
Affiliation as printed
Breast Cancer Unit, Greater Poland Cancer Centre, Poznan, Poland
-
Affiliation as printed
Breast Unit S. Anna Hospital, Turin, Italy
-
Haydarpaşa Numune Eğitim ve Araştırma Hastanesi · Sağlık Bilimleri Üniversitesi
Affiliation as printed
Department of General Surgery, Istanbul Haydarpasa Numune Training and Research Hospital, University of Health Sciences Turkey, İstanbul, Turkey
-
Affiliation as printed
Department of Obstetrics and Gynecology, Helios Hospital Berlin-Buch, Berlin-Buch, Germany
-
Brüderkrankenhaus St. Josef Paderborn
Affiliation as printed
Department of Gynecology and Obstetrics, Frauenklinik St Louise, Paderborn, Frauenklinik St Josefs-Krankenhaus, Salzkotten, St Vincenz Kliniken, Paderborn, Germany
-
Affiliation as printed
EUBREAST e.V., Esslingen, Germany
-
Affiliation as printed
Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
-
Universitätsmedizin Rostock · University of Rostock
Affiliation as printed
Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany
-
University Hospital Schleswig-Holstein
Affiliation as printed
Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lübeck, Germany
-
University Hospital Schleswig-Holstein
Affiliation as printed
Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lübeck, Germany
-
Affiliation as printed
Department of Oncoplastic Breast Surgery, Hamad Medical Corporation, Doha, Qatar
-
Heinrich Heine University Düsseldorf
Affiliation as printed
Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
-
Affiliation as printed
Queen Sirikit Centre for Breast Cancer, Bangkok, Thailand
-
Affiliation as printed
Breast Center, Die Filderklinik, Germany
Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
Cited by 4 stored of 4
4 results
No patents citing this paper on Lens.org (checked 2026-10-06).