Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)
- PMID: 40587927
- DOI: 10.1016/j.ejso.2025.110253
Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)
Abstract
Introduction: Marking metastatic lymph nodes before neoadjuvant chemotherapy (NACT) has become increasingly popular in the surgical treatment of breast cancer. A variety of devices are currently in use. However, the significance of lost markers is poorly understood, and their impact on clinical decisions is unclear.
Materials and methods: Among participants enrolled in the prospective AXSANA cohort study, those planned for target lymph node biopsy (TLNB) or targeted axillary dissection (TAD) with completed post-NACT locoregional therapy (surgery and radiotherapy) by January 21, 2025, were included.
Results: In 88 of 1528 patients (5.8 %), axillary markers could not successfully be removed during surgery after NACT. The lost marker rate differed depending on the marker type (metallic clip/coil 7.0 %, carbon 3.1 %, radar reflector 1.4 %, magnetic seed 0.6 %, radioactive seed 0.0 %, p < 0.001). Additional postoperative imaging was performed in 25 (28.4 %) and further surgery to remove axillary markers was performed in 6 (6.8 %) patients with lost markers. The proportion of patients undergoing axillary lymph node dissection (46.6 % versus 36.5 %, p 0.069) and axillary radiotherapy (51.1 % versus 50.2 %, p 0.748) did not differ between patients with and without lost markers. After an average follow-up of 21.8 months, axillary recurrences occurred in 3 patients (3.3 %) with and 16 patients (1.0 %) without lost markers (rate ratio 2.89, p 0.088).
Conclusion: The loss of markers in TLNB/TAD is uncommon and significantly depends on the marking technique. Lost markers may lead to diagnostic uncertainties and additional imaging or surgical procedures.
Keywords: Axillary surgery; Breast cancer; Lost marker; Neoadjuvant chemotherapy; Target lymph node.
Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of competing interest 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; Study support: Korean Breast Cancer Society, Eugen & Irmgard Hahn Stiftung, EndoMag, Mammotome, MeritMedical, Sirius Medical, Gilead, Hologic, ExactSciences, Claudia von Schilling Stiftung, Damp Stiftung, Ehmann Stiftung Savognin; Travel reimbursement: Eli Lilly, ExactSciences, Pierre Fabre, Pfizer, Daiichi Sankyo, Roche, Stemline. Oreste Davide Gentilini: Honoraria for lectures and consultations from: MSD, Eli-Lilly, AstraZeneca, Bayer, BD. Guldeniz Karadeniz Cakmak: Congress support: Roche, Abbott, Medtronic, Sirius Medical; Lecture honoraria: Roche, Sirius Medical, Medtronic; Trial honoraria: United Nations. Maria Luisa Gasparri: Consultant for Merit Medical. David Pinto: Honoraria for lectures from MSD. Marc Thill: Honoraria for advisory role from: Agendia, Amgen, AstraZeneca, Aurikamed, Becton/Dickinson, ClearCut, Daiichi Sankyo, Eisai, Exact Sciences, Gilead Science, Grünenthal, GSK, Lilly, MSD, Neodynamics, Novartis, Onkowissen, Organon, Pfizer, pfm Medical, Pierre-Fabre, Roche, Saman Tree, Seagen, Sirius Medical, Sysmex, Titanium Textiles; Manuscript support from: Amgen, Cairn Surgical ClearCut, Clovis, Lilly, Organon, pfm medical, Roche, Servier; Travel reimbursement: Amgen, Art Tempi, AstraZeneca, Clearcut, Daiichi Sankyo, Eisai, Exact Sciences, Gilead, Hexal, I-Med-Institute, Lilly, Menarini Stemline, MSD, Neodynamics, Novartis, Pfizer, pfm Medical, Roche, RTI Surgical, Seagen, ZP Therapeutics; Congress support: Amgen, AstraZeneca, Daiichi Sanyko, Gilead, Hexal, Lilly, Menarini Stemline, Neodynamics, Novartis, Pfizer, pfm medical, Pierre Fabre, Roche, Sirius Medical; Lecture honoraria: Agendia, Amgen, Art Tempi, AstraZeneca, Eisai, Endomag, Exact Sciences, Gilead Science, GSK, Hexal, I-Med-Institute, Jörg Eickeler, Johnson and Johnson, Laborarztpraxis Walther et al., Lilly, Medscape, Menarini Stemline, MSD, Novartis, Onkowissen, Pfizer, pfm medical, Roche, Seagen, Sirius Medical, StreamedUp, Sysmex, Vifor, Viatris, ZP Therapeutics; Study support: AstraZeneca, Biom’Up, CairnSurgical, Clearcut, Endomag, Exact Sciences, Neodynamics, Novartis, pfm medical, Roche, RTI Surgical. Michael Patrick Lux: Honoraria for advisory role from Endomag. Sibylle Loibl: Grants and/or honorarium for adboards and/or contracts from the following entities/all paid to institution: AZ, Abbvie, Agendia, Amgen, BionTech, Celgene/BMS, Cellcuity, DSI, Exact Science, Gilead, GSK, Incyte, Lilly, Medscape, Molecular Health, MSD, Novartis, Pierre Fabre, Pfizer, Relay, Roche, Sanofi, Seagen, Stemline/Menarini, Olema, Bayer, Bicycle, JAZZ Pharma, BeiGene; Support for attending meetings and/or travel: DSI, ESMO, SGBCC, ASCO, AGO Kommission Mamma; Patents planned, issued or pending: EP14153692.0/EP21152186.9/EP18209672/EP24210258; Royalties: VM Scope. Jens-Uwe Blohmer: Honoraria for lectures and advisory role from: AstraZeneca, Daiichi Sankyo, Eisai, Gilead, Lilly, MSD, Novartis, Pfizer, Roche; Study support: BKG, BMBF, GBA, DKH, DKTK. Thorsten Kühn: Honoraria from: MSD, Exact Sciences, Novartis, Lilly, Merit Medical, Sirius Pintuition, Endomag, Daichi Sanyo. Other authors declare no competing interests.
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