Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)
- Authors: 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.; 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.; Blohmer, J.; 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.; 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.; Kruse, J.; 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.; 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.; 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.; 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.
- Publication year: 2025
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/698353
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.