Artigo

Marking Techniques for Target Lymph Nodesin Node-Positive Breast Cancer Treated With NeoadjuvantTherapy in the AXSANA/EUBREAST-03/AGO-B-053 Study

Autor(es): Maggie Banys-Paluchowski, PhD 1 Elmar Stickeler, PhD 9 ; Steffi Hartmann, PD 2 ; Jana de Boniface, PhD 3,4 ; Guldeniz Karadeniz Cakmak, PhD 10 ; Oreste D. Gentilini, PhD 5,6 ; Michael Hauptmann, PhD 11 ; Nina Ditsch, PhD 7,8 ; Jennifer Schroth 11 ; Marc Thill, PhD 12 ; Rosa di Micco, MD 6 Laura Niinikoski, MD 19 ; Markus Hahn, PhD 13 ; Dawid Murawa, PhD 14,15 ; Isabel T. Rubio, PhD 16 ; David Pinto, MD 17 ; ; Michalis Kontos, PhD 18 ; ; Maria Luisa Gasparri, PhD 20,21 ; Helidon Nina, PhD 22 ; Lia P. Rebaza, MD 23 Esther Schmidt, MD 2 ; Kristina Wihlfahrt, MD 24 ; Tomasz Berger, MD 25 ; Timo Basali, MD 26 Eduard-Alexandru Bonci, PhD 28,29 ; Sarah Fr¨ ohlich, MD 2 ; ; Franziska Ruf, MD 1 ; Angelika Rief, MD 27 ; Florentia Peintinger, PhD 25,30 ; Ellen Schlichting, PhD 31 ; Hagigat Valiyeva Qanimat, PhD 32 ; Marian Vanhoeij, PhD 33 ; Geeta Kadayaprath, MD 34 ; Lukas Dostalek, PhD 35 ; Ashutosh Kothari, PhD 36 ; Andraz Perhavec, MD 37 ; ; Tsvetomir Ivanov, MD 38 Michael Untch, PhD 43 ; Douglas Zippel, MD 39 ; Beata Adamczyk, MD 40 ; Mauro Porpiglia, MD 41 ; G¨ unay M. G¨ urleyik, MD 42 ; Michael P. Lux, PhD 44 ; Katharina Jursik, MS 45 ; Hans-Christian Kolberg, PhD 46 ; Toralf Reimer, PhD 2 ; ; Nikolas Tauber, MD 1 Thorsten K¨ uhn, PhD 50,51

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%), radio frequency 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 carbonink (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.