Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)

Hartmann S.; Banys-Paluchowski M.; Berger T.; Ditsch N.; Stickeler E.; de Boniface J.; Gentilini O.D.; Schroth J.; Karadeniz Cakmak G.; Rubio I.T.; Gasparri M.L.; Kontos M.; Bonci E.-A.; Niinikoski L.; Murawa D.; Kadayaprath G.; Pinto D.; Peintinger F.; Schlichting E.; Dostalek L.; Nina H.; Valiyeva H.; Vanhoeij M.; Perhavec A.; Zippel D.; Rebaza L.P.; Thongvitokomarn S.; Fröhlich S.; Ruf F.; Rief A.; Wihlfahrt K.; Basali T.; Thill M.; Lux M.P.; Loibl S.; Kolberg H.-C.; Blohmer J.-U.; Hahn M.; Gurleyik M.G.; Porpiglia M.; Gunay S.; Zetterlund L.; Kuehn T.; Kolacinska-Wow A.; Silva A.; Fancellu A.; Hein A.; Miller A.; Thodas A.; Cruz A.I.; Musina A.-M.; Fleuster A.; Stefek A.; Putz A.; Lorek A.; Kleine-Tebbe A.; Smeets A.; Madej-Mierzwa A.; Bachmann A.; Lebeau A.; Lebrecht A.; Nixdorf A.; Grasso A.; Cordoba A.C.; Marano A.; Madrona A.P.; Goel A.K.; Sezer A.; Kothari A.; Gatzweiler A.; Leite B.C.; Schlesinger B.; Adamczyk B.; Janke B.; Lex B.; Sezen B.A.; Königs-El-Amrawy B.; Cipolla C.; Paschold C.; Schulte-Tiwisinia C.; Nestle-Krämling C.; Ugur C.M.; Yilmaz C.; Schindlbeck C.; Ankel C.; Solbach C.; Zeder-Goess C.; Anthuber C.; Großmann C.; Mayr C.; Scholz C.; Uras C.; Maurer C.; Müller C.; Neumann C.; Meisel C.; Peternell C.; Fuhljahn C.; Kühn C.; Langanke D.; De Tullio D.; Dieterle D.; Rezek D.; Bolla D.; Müller D.J.; Mink D.; Watermann D.; Fischer D.; Simon E.; von Abel E.; Ignatiadou E.; Shaari E.; Faust E.; Keil E.; Villa E.B.; Esposito E.; Schmidt E.; Klein E.; Corsi F.; Bacelar F.; Ebner F.; Guerini F.; Beldermann F.; Bilow F.; Thele F.; Fromm F.F.; Federspiel F.K.; Wärnberg F.; Feisel-Schwickardi G.; Kaltenecker G.; Stalzer G.; Franceschini G.; Tazzioli G.; Armatura G.; Xepapadakis G.; Nia H.H.; Karanlik H.; Skerjven H.K.; Eichler H.; Heidegger H.; Bekes I.; Bauerfeind I.; Thalmann I.; Buck I.; Natasiopoulos I.; Lerena I.C.; Utz-Billing I.; Himsl I.; Palatty J.; Kosse J.; Schnabel J.; Seldte J.-P.; Kruse J.-P.; Leitsmann J.; Wagner J.; Rom J.; Czihak J.; Lecht J.; Lehmann J.; Sanchez-Mendez J.I.; Fougo J.L.; Farthmann J.; Schuster J.; Lefarth J.; Wimmer-Freys K.; Chrobak-Kasprzyk K.; Aßmann K.; Jursik K.; Engelken K.; Roth K.; Hilmer K.; Ramaker K.; Winkler K.; Pankert K.; Unterrieder K.; Ahsberg K.; Freese K.; Scheerer K.; Bauer L.; Brandt L.-K.; Johnsen L.; Adwall L.; Steinhilper L.; Melnichuk L.; Lorente L.L.; Dogan L.; Ugurlu M.U.; Sanchez Barron M.T.; Smidt M.; Hofmann M.; Hufnagel M.; Sciamannini M.; Santos M.; Mangold M.; Taffurelli M.; Paul M.; Hansen M.H.; Höing M.; Keller M.; Walcher M.; D'Aiuto M.; Busani M.; Frank M.; Gülcelik M.A.; Berghorn M.; Burkhardt M.; Eichbaum M.; Hauptmann M.; Schrauder M.; Untch M.; Weigel M.; Kühn N.; Ruyssers N.; Krawczyk N.; Deuerling N.; Cabioglu N.; Rocco N.; Stahl N.; Bangemann N.; Argudo N.; Tomé O.; Agcaoglu O.; Diem P.; Dall P.; Diebold P.; Fehr P.; Bolkenius P.; Pluta P.; Völker R.; Malterling R.R.; Buss-Steidle R.; Felberbaum R.; Berger R.; Rodriguez R.; Iosifidou R.; Oom R.; Andrés-Luna R.; Lemster S.; Riemer S.; Schmatloch S.; Rauen S.; Wetzig S.; Majid S.; Gurdal S.O.; Perez S.; Mattes S.; Michieletto S.; Ovalle S.C.; Kommos S.; Lukic S.; Renner S.; Liebers S.; Hasmüller S.; Seitz S.; Ribeiro S.P.; Albrecht S.; Barrot S.; Bucher S.; Kraudelt S.; Peschel S.; Grasshoff S.-T.; Hadar T.; Abraham T.; Wanik T.; Salazar T.C.; Pursche T.; Erbes T.; Hildebrandt T.; Noesselt T.; Papathemelis T.; Lantzsch T.; Nowikiewicz T.; Reimer T.; Ivanov T.; Denison U.; Makowiec U.; Scholz U.; Fenske U.; Felten U.; Albert U.-S.; Bounous V.E.; Venizelos V.; Vural V.; Bjelic-Radisic V.; Hagen V.; Soos V.; Hanf V.; Ruhwedel W.; Heyl W.; Seifert W.; Sidiropoulou Z.; Nowecki Z.I. · European Journal of Surgical Oncology (2025) · DOI: 10.1016/j.ejso.2025.110253

Resumen

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.