Multicenter Study

. 2025 May;211(1):203-211.

doi: 10.1007/s10549-025-07635-4. Epub 2025 Feb 20.

Radar reflectors for marking of target lymph nodes in initially node-positive patients receiving neoadjuvant chemotherapy for breast cancer-a subgroup analysis of the prospective AXSANA (EUBREAST-03) trial

Maggie Banys-Paluchowski^#¹, Steffi Hartmann^#², Timo Basali³, Maria Luisa Gasparri^{4

5}, Jana de Boniface^{6

7}, Oreste Davide Gentilini^{8

9}, Güldeniz Karadeniz Cakmak¹⁰, Nina Ditsch¹¹, Elmar Stickeler^{12

13}, Ellen Schlichting¹⁴, Isabel Rubio¹⁵, Florentia Peintinger^{16

17}, Michael Untch¹⁸, Christine Mau¹⁸, Frederike Klaassen Federspiel¹⁹, Susanne Bucher²⁰, Kerstin Ramaker²¹, Peter Paluchowski²¹, Lelia Bauer²², Sabine Riemer²³, Dagmar Langanke²⁴, Tanja Durpektova Leuf²⁵, Jens Schnabel²⁶, Ekkehard von Abel²⁷, Christine Solbach²⁸, Sonja Cáradenas Ovalle²⁹, Kerstin Hilmer³⁰, Vesna Bjelic-Radisic^{31

32}, Nicole Stahl³³, Jose I Sanchez-Mendez³⁴, Vibeke Hagen³⁵, Marit Helene Hansen³⁶, Natalia Krawczyk³⁷, Bilge Aktas Sezen³⁸, Katharina Jursik³⁸, Marc Thill³⁹, Hans-Christian Kolberg⁴⁰, Toralf Reimer², Franziska Ruf⁴¹, Kristina Wihlfahrt⁴², Angelika Rief⁴³, Tomasz Berger⁴⁴, Esther Schmidt², Nikolas Tauber⁴¹, Sarah Fröhlich², Thorsten Kühn^{45

46}

Affiliations

¹ Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lubeck, Germany. Maggie.Banys-Paluchowski@uksh.de.
² Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany.
³ Department of Gynecology and Obstetrics, Hospital Esslingen, Esslingen, Germany.
⁴ Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.
⁵ Faculty of Biomedicine, University of the Italian Switzerland (USI), Lugano, Switzerland.
⁶ Department of Surgery, Breast Center, Capio St. Göran's Hospital, Stockholm, Sweden.
⁷ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁸ Breast Surgery Unit, Universita Vita-Salute San Raffaele, Milan, Italy.
⁹ Breast Surgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
¹⁰ Breast and Endocrine Unit, General Surgery Department, Zonguldak BEUN The School of Medicine, Zonguldak, Turkey.
¹¹ Gynecology, Obstetrics and Senology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany.
¹² Department of Gynecology and Obstetrics, University Hospital Aachen, Aachen, Germany.
¹³ Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany.
¹⁴ Department of Oncology, Oslo University Hospital, Oslo, Norway.
¹⁵ Breast Surgical Unit, Clínica Universidad de Navarra, Madrid, Spain.
¹⁶ Department of Gynecology and Obstetrics, University Hospital Graz, Graz, Austria.
¹⁷ Institute of Pathology, Medical University of Graz, Graz, Austria.
¹⁸ Department of Obstetrics and Gynecology, Helios Hospital Berlin-Buch, Buch, Berlin, Germany.
¹⁹ Department of Senology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
²⁰ Breast Center, Cantonal Hospital Luzern, Lucerne, Switzerland.
²¹ Breast Center Pinneberg, Regio Hospitals, Pinneberg, Germany.
²² Department of Obstetrics and Gynecology, GRN Hospital Weinheim, Weinheim, Germany.
²³ Department of Obstetrics and Gynecology, St. Joseph Stift Bremen, Bremen, Germany.
²⁴ Department of Senology and Breast Center, St. Elisabeth Hospital, Leipzig, Germany.
²⁵ Department of Gynecology and Breast Center, Asklepios Hospital, Weissenfels, Germany.
²⁶ Department of Obstetrics and Gynecology, DRK Hospital Chemnitz Rabenstein, Chemnitz, Germany.
²⁷ Department of Obstetrics and Gynecology, Staufer Hospital Mutlangen, Mutlangen, Germany.
²⁸ Department of Obstetrics and Gynecology, University Hospital Frankfurt, Frankfurt, Germany.
²⁹ Department of Gynecology, Protestant Forest Hospital Spandau, Spandau, Germany.
³⁰ Department of Obstetrics and Gynecology, Helios Hospital Gifhorn GmbH, Gifhorn, Germany.
³¹ Breast Center, Helios University Hospital, Wuppertal, Germany.
³² University Witten/Herdecke, Herdecke, Witten, Germany.
³³ Breast Center, Helios Hospital Schwerin, Schwerin, Germany.
³⁴ Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain.
³⁵ Department of Gynecology, St. Olavs Hospital, Trondheim, Norway.
³⁶ Department of Breast and Endocrine Surgery, The Arctic University of Norway, Tromsoe, Norway.
³⁷ Department of Obstetrics and Gynecology, University Hospital Düsseldorf, Dusseldorf, Germany.
³⁸ EUBREAST e.V., Esslingen, Germany.
³⁹ Department of Gynecology and Gynecological Oncology, Agaplesion Markus Hospital, Frankfurt, Germany.
⁴⁰ Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany.
⁴¹ Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lubeck, Germany.
⁴² Practice for Gynecology and Obstetrics Wihlfahrt, Kiel, Germany.
⁴³ Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria.
⁴⁴ Department of Gynecology and Obstetrics, Müritz-Klinikum Waren, Waren, Germany.
⁴⁵ Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany.
⁴⁶ Breast Center, Die Filderklinik, Filderstadt, Germany.

^# Contributed equally.

PMID: 39976867
DOI: 10.1007/s10549-025-07635-4

Multicenter Study

Radar reflectors for marking of target lymph nodes in initially node-positive patients receiving neoadjuvant chemotherapy for breast cancer-a subgroup analysis of the prospective AXSANA (EUBREAST-03) trial

Maggie Banys-Paluchowski et al. Breast Cancer Res Treat. 2025 May.

. 2025 May;211(1):203-211.

doi: 10.1007/s10549-025-07635-4. Epub 2025 Feb 20.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lubeck, Germany. Maggie.Banys-Paluchowski@uksh.de.
² Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany.
³ Department of Gynecology and Obstetrics, Hospital Esslingen, Esslingen, Germany.
⁴ Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.
⁵ Faculty of Biomedicine, University of the Italian Switzerland (USI), Lugano, Switzerland.
⁶ Department of Surgery, Breast Center, Capio St. Göran's Hospital, Stockholm, Sweden.
⁷ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁸ Breast Surgery Unit, Universita Vita-Salute San Raffaele, Milan, Italy.
⁹ Breast Surgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
¹⁰ Breast and Endocrine Unit, General Surgery Department, Zonguldak BEUN The School of Medicine, Zonguldak, Turkey.
¹¹ Gynecology, Obstetrics and Senology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany.
¹² Department of Gynecology and Obstetrics, University Hospital Aachen, Aachen, Germany.
¹³ Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany.
¹⁴ Department of Oncology, Oslo University Hospital, Oslo, Norway.
¹⁵ Breast Surgical Unit, Clínica Universidad de Navarra, Madrid, Spain.
¹⁶ Department of Gynecology and Obstetrics, University Hospital Graz, Graz, Austria.
¹⁷ Institute of Pathology, Medical University of Graz, Graz, Austria.
¹⁸ Department of Obstetrics and Gynecology, Helios Hospital Berlin-Buch, Buch, Berlin, Germany.
¹⁹ Department of Senology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
²⁰ Breast Center, Cantonal Hospital Luzern, Lucerne, Switzerland.
²¹ Breast Center Pinneberg, Regio Hospitals, Pinneberg, Germany.
²² Department of Obstetrics and Gynecology, GRN Hospital Weinheim, Weinheim, Germany.
²³ Department of Obstetrics and Gynecology, St. Joseph Stift Bremen, Bremen, Germany.
²⁴ Department of Senology and Breast Center, St. Elisabeth Hospital, Leipzig, Germany.
²⁵ Department of Gynecology and Breast Center, Asklepios Hospital, Weissenfels, Germany.
²⁶ Department of Obstetrics and Gynecology, DRK Hospital Chemnitz Rabenstein, Chemnitz, Germany.
²⁷ Department of Obstetrics and Gynecology, Staufer Hospital Mutlangen, Mutlangen, Germany.
²⁸ Department of Obstetrics and Gynecology, University Hospital Frankfurt, Frankfurt, Germany.
²⁹ Department of Gynecology, Protestant Forest Hospital Spandau, Spandau, Germany.
³⁰ Department of Obstetrics and Gynecology, Helios Hospital Gifhorn GmbH, Gifhorn, Germany.
³¹ Breast Center, Helios University Hospital, Wuppertal, Germany.
³² University Witten/Herdecke, Herdecke, Witten, Germany.
³³ Breast Center, Helios Hospital Schwerin, Schwerin, Germany.
³⁴ Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain.
³⁵ Department of Gynecology, St. Olavs Hospital, Trondheim, Norway.
³⁶ Department of Breast and Endocrine Surgery, The Arctic University of Norway, Tromsoe, Norway.
³⁷ Department of Obstetrics and Gynecology, University Hospital Düsseldorf, Dusseldorf, Germany.
³⁸ EUBREAST e.V., Esslingen, Germany.
³⁹ Department of Gynecology and Gynecological Oncology, Agaplesion Markus Hospital, Frankfurt, Germany.
⁴⁰ Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany.
⁴¹ Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lubeck, Germany.
⁴² Practice for Gynecology and Obstetrics Wihlfahrt, Kiel, Germany.
⁴³ Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria.
⁴⁴ Department of Gynecology and Obstetrics, Müritz-Klinikum Waren, Waren, Germany.
⁴⁵ Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany.
⁴⁶ Breast Center, Die Filderklinik, Filderstadt, Germany.

^# Contributed equally.

PMID: 39976867
DOI: 10.1007/s10549-025-07635-4

Abstract

Background: Surgical staging procedures of the axilla in initially clinically node-positive (cN +) breast cancer patients receiving neoadjuvant chemotherapy (NACT) vary across countries. Different procedures such as axillary lymph node dissection, sentinel lymph node biopsy, target lymph node biopsy and targeted axillary dissection are currently in use. To date, data on radar reflectors as a non-wire and non-radioactive technique for marking target lymph nodes are limited. The present study aims at examining the detection rate, the rate of lost markers, and magnetic resonance imaging artifacts after TLN marking using a radar reflector before NACT in the largest available cohort of breast cancer patients enrolled in the international prospective AXSANA study.

Methods: AXSANA (EUBREAST-03) is an international prospective cohort study including cN + patients managed with different surgical axillary staging techniques after NACT. Eligible patients have cT1-4c cN + breast cancer and receive neoadjuvant chemotherapy. Patients are followed up for 5 years. In the present subgroup analysis, only patients with a TLN marked by a radar reflector were included.

Results: A TLN was marked by radar reflector insertion in 158 patients prior to NACT. Of these, 136 had final surgery results available at the time of analysis, and in 135 out of these 136 patients, localization of TLN was attempted. All radar markers were successfully removed. While lymphoid tissue corresponding to the TLN was identified in 132 patients (97.8%), no lymphoid tissue was detected on histopathology in three patients. It remains unclear whether the TLN was excised in these cases or not. In 1 out of 27 patients (3.7%) who underwent preoperative MRI, image assessment was compromised due to artifacts after radar marker placement.

Conclusion: To the best of our knowledge, this is the largest prospective series of patients receiving a radar reflector for the marking of a TLN prior to NACT for breast cancer. Our data demonstrate that radar reflectors are a reliable tool for marking target lymph nodes before neoadjuvant treatment.

Trial registration number: NCT04373655 (date of registration May 4, 2020).

Keywords: Breast cancer; Neoadjuvant chemotherapy; Radar reflector; Recurrence; Target lymph node; Targeted axillary dissection.

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Conflict of interest statement

Declarations. Competing interests: Maggie Banys-Paluchowski: Honoraria for lectures and advisory role from: Roche, Novartis, Pfizer, pfm, Eli Lilly, Onkowissen, Seagen, AstraZeneca, Eisai, Amgen, Samsung, Canon, MSD, GSK, Daiichi Sankyo, Gilead, Sirius Medical, Syantra, resitu, Pierre Fabre, ExactSciences, Menarini Stemline; Study support: EndoMag, Mammotome, MeritMedical, Sirius Medical, Gilead, Hologic, ExactSciences, Claudia von Schilling Foundation for Breast Cancer Research, Ehmann-Stiftung Savognin; Travel reimbursement: Eli Lilly, ExactSciences, Pierre Fabre, Pfizer, Daiichi Sankyo, Roche Hans-Christian Kolberg: Honorare for lectures and advisory role from Pfizer, Seagen, Novartis, Roche, Genomic Health/Exact Sciences, Amgen, AstraZeneca, Riemser, Carl Zeiss Meditec, TEVA, Theraclion, Janssen-Cilag, GSK, LIV Pharma, Lilly, SurgVision, Onkowissen, Gilead, Daiichi Sankyo and MSD, Travel support from Carl Zeiss meditec, LIV Pharma, Novartis, Amgen, Pfizer, Daiichi Sankyo, Gilead, Roche, Onkowissen and Tesaro; Stock ofTheraclion SA. Jana de Boniface: Honoraria for lectures for Astra Zeneca, Lily and Novartis Nina Ditsch: Advisory Boards: Gilead, Lilly, MSD, Novartis, Pfizer, Roche, Seagen, Exact Sciences, Lectures: AstraZeneca, Daiichi-Sankyo, Exact Sciences, Pierre-Fabre, I-Med-Institute, Merit-Medical, pfm medical ag, Medi-Seminar GmbH, Roche, Lilly, Pfizer, Gilead, Novartis, Manuscript: pfm medical ag, Trial funding: Gilead, BZKF, Other: Onkowissen, Jörg Eickeler Kongress, if-Kongress Vesna Bjelic-Radisic: Honoraria for lectures and advisory role from: Roche, Novartis, Pfizer, pfm, Eli Lilly, AstraZeneca, Gilead, Sirius Medical, Pierre Fabre, Mammotome, Travel reimbursement: Pierre Fabre, Pfizer Maria Luisa Gasparri: Consultant for Merit Medical Nikolas Tauber: Honoraria for lectures and participation in advisory boards: Novartis, ExactSciences, Georg Thieme Verlag. Support for attending meetings from Astra Zeneca Marc Thill: Advisory Board: Agendia, Amgen, AstraZeneca, Aurikamed, Becton/Dickinson, Biom ‘Up, ClearCut, Clovis, Daiichi Sankyo, Eisai, Exact Sciences, Gilead Science, Grünenthal, GSK, Lilly, MSD, Neodynamics, Novartis, Onkowissen, Organon, Pfizer, pfm Medical, Pierre-Fabre, Roche, Seagen, Sirius Medical, Sysmex; Manuscript support: Amgen, ClearCut, Clovis, Lilly, Organon, pfm medical, Roche, Servier; Travel expenses: Amgen, Art Tempi, AstraZeneca, Clearcut, Clovis, Connect Medica, Daiichi Sankyo, Eisai, Exact Sciences, Gilead, Hexal, I-Med-Institute, Lilly, MSD, Neodynamics, Novartis, Pfizer, pfm Medical, Roche, RTI Surgical, Seagen, ZP Therapeutics; Congress support: Amgen, AstraZeneca, Celgene, Daiichi Sanyko, Gilead, Hexal, Lilly, Neodynamics, Novartis, Pfizer, Pierre Fabre, Roche, Sirius Medical; Lecture honoraria: Agendia, Amgen, Art Tempi, AstraZeneca, Clovis, Connect Medica, Eisai, Endomag, Exact Sciences, Gedeon Richter, Gilead Science, GSK, Hexal, I-Med-Institute, Jörg Eickeler, Laborarztpraxis Walther et al., Lilly, Medscape, MSD, Novartis, Onkowissen, Pfizer, pfm medical, Roche, Seagen, StreamedUp, Stemline, Sysmex, Vifor, Viatris, ZP Therapeutics; Trial Funding: Endomag, Exact Sciences; Trial honoraria: AstraZeneca, Biom’Up, CairnSurgical, Clearcut, Neodynamics, Novartis, pfm medical, Roche, RTI Surgical. Other authors declare no competing interests. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University Aachen, Germany (Date: April 28, 2020, Number: EK 013/20). Informed consent: Informed consent was obtained from all individual participants included in the study.

References

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Radar reflectors for marking of target lymph nodes in initially node-positive patients receiving neoadjuvant chemotherapy for breast cancer-a subgroup analysis of the prospective AXSANA (EUBREAST-03) trial

Affiliations

Radar reflectors for marking of target lymph nodes in initially node-positive patients receiving neoadjuvant chemotherapy for breast cancer-a subgroup analysis of the prospective AXSANA (EUBREAST-03) trial

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical

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