Marking Techniques for Target Lymph Nodes in Node-Positive Breast Cancer Treated With Neoadjuvant Therapy in the...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Surgical axillary staging for node-positive breast cancer (BC) has evolved with neoadjuvant chemotherapy (NACT).
• Targeted axillary dissection (TAD) and target lymph node biopsy (TLNB) are increasingly utilized.
• Limited data exists on the comparative performance of different lymph node marking techniques.

Purpose of the Study:

• To evaluate and compare various marking techniques for target lymph nodes (TLNs) in breast cancer patients undergoing NACT.
• To assess detection and removal rates and clinical performance of different TLN marking methods.
• To analyze data from the largest prospective cohort worldwide on TLN marking techniques.

Main Methods:

• Prospective evaluation of patients from the AXSANA (EUBREAST-03) multicenter study.
• Inclusion of patients who received TLN marking followed by TAD or TLNB.
• Analysis of marking methods based on detection rates, removal rates, and clinical performance.

Main Results:

• Over 6,000 patients enrolled; 2,596 had marked TLNs and completed surgery.
• Clip marking was most common (77.2%), followed by magnetic seed (11.1%) and carbon ink (7.4%).
• Probe-guided detection markers (radioactive seed, magnetic seed, radar marker, RFID) demonstrated the highest TLN detection rates (96.6%) compared to carbon ink (94.9%) and clip (89.6%).

Conclusions:

• Probe-guided detection markers significantly improve target lymph node detection rates in breast cancer patients receiving NACT.
• These findings support the use of probe-guided markers for enhanced axillary staging in this patient population.
• The study provides robust evidence from a large prospective cohort on the superiority of specific marking techniques.