Ideal marker for targeted axillary dissection (IMTAD): a prospective multicentre trial

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Targeted axillary dissection (TAD) is crucial for axillary staging in breast cancer patients post-neoadjuvant chemotherapy (NAC).
• Accurate lymph node marking before NAC is essential for successful TAD.
• Reliable markers ensure effective sentinel lymph node biopsy and targeted lymph node excision.

Purpose of the Study:

• To compare the reliability, accuracy, and safety of three localization markers for TAD.
• To evaluate complication rates during marker implantation and detection.
• To assess marker dislodgement rates in the IMTAD prospective multicentre trial.

Main Methods:

• Prospective multicentre trial (IMTAD study) involving 189 breast cancer patients.
• Comparison of three lymph node localization markers: clip+iodine seed, magnetic seed, and carbon suspension.
• Evaluation of primary outcomes including reliability, accuracy, safety, complication rates, and marker dislodgement.

Main Results:

• No statistically significant difference in complication rates between the three markers (p=0.263 for implantation, p=0.117 for detection).
• Marker dislodgement occurred in 3.0% of patients using clip+iodine seeds; none with other methods (p=0.999).
• False-negativity rate for targeted lymph nodes (TLN) was 0.0% in ypN+ patients, significantly lower than for sentinel lymph nodes (SLN) (9.6%).

Conclusions:

• Clip+iodine seed, magnetic seed, and carbon suspension are comparable, safe, accurate, and reliable markers for TAD.
• The study confirms the lower false-negativity rate of TLN compared to SLN for axillary lymph node status assessment after NAC.
• Targeted lymph nodes (TLN) are a superior marker for axillary staging post-NAC compared to sentinel lymph nodes (SLN).