Senologie - Zeitschrift für Mammadiagnostik und -therapie 2025; 22(02): e13-e14
DOI: 10.1055/s-0045-1807661
Abstracts

Consequences of lost axillary markers after neoadjuvant chemotherapy in breast cancer patients – data from the prospective international AXSANA cohort study (NCT04373655)

Authors

  • S Hartmann

    1   Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany

  • M Banys-Paluchowski

    2   Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

  • T Berger

    3   Department of Gynecology and Obstetrics, Müritz-Klinikum Waren, Waren, Germany

  • N Ditsch

    4   Gynecology, Operative and Conservative Senology, Faculty of Medicine, University of Augsburg, Augsburg, Germany

  • E Stickeler

    5   Department of Gynecology and Obstetrics, University Hospital Aachen, Aachen, Germany

  • J de Boniface

    6   Department of Surgery, Breast Center, Capio St. Göran's Hospital, Stockholm, Sweden
    7   Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

  • O D Gentilini

    8   Breast Surgery Unit, San Raffaele University and Research Hospital, Milan, Italy

  • J Schroth

    9   Brandenburg Medical School Theodor Fontane, Neuruppin, Germany

  • G Karadeniz Cakmak

    10   Zonguldak BEUN The School of Medicine, General Surgery Department, Breast and Endocrine Unit, Zonguldak, Turkey

  • I T Rubio

    11   Breast Surgical Unit, Clínica Universidad de Navarra, Madrid, Spain

  • M L Gasparri

    12   Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland
    13   University of the Italian Switzerland (USI), Faculty of Biomedicine, Lugano, Switzerland

  • M Kontos

    14   Department of Surgery, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece

  • E-A Bonci

    15   Department of Surgical Oncology, ”Prof. Dr. Ion Chiricuță” Institute of Oncology,, Cluj-Napoca, Romania
    16   Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

  • L Niinikoski

    17   Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland

  • D Murawa

    18   Department of General Surgery and Surgical Oncology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland

  • G Kadayaprath

    19   MAX Hospital, Patparganj, New Delhi, India

  • D Pinto

    20   Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisboa, Portugal

  • F Peintinger

    21   Institute of Pathology, Medical University of Graz, Graz, Austria
    22   Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria

  • E Schlichting

    23   Department of Oncology, Oslo University Hospital, Oslo, Norway

  • L Dostalek

    24   Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic

  • H Valiyeva Qanimat

    25   Oncologic Clinic of Azerbaijan Medical University, Baku, Azerbaijan

  • H Nina

    26   Department of Surgery, Oncology Hospital, Tirana, Albania

  • A Kothari

    27   Guy's & St Thomas NHS Foundation Trust, London, United Kingdom

  • M Vanhoeij

    28   Universitair Ziekenhuis Brussel, Brussel, Belgium

  • A Perhavec

    29   Institute of Oncology Ljubljana, Ljubljana, Slovenia

  • T Ivanov

    30   Heart and Brain Hospital, Pleven, Bulgaria

  • D Zippel

    31   Surgical Oncology Unit Chaim Sheba Medical Centre, Ramat Gan, Israel

  • L P Rebaza

    32   Breast Surgery, Oncosalud, Lima, Peru

  • S Thongvitokomarn

    33   Queen Sirikit Centre for Breast Cancer, Bangkok, Thailand

  • S Fröhlich

    1   Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany

  • F Ruf

    2   Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

  • A Rief

    22   Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria

  • E Schmidt

    1   Department of Gynecology and Obstetrics, University Hospital Rostock, Rostock, Germany

  • K Wihlfahrt

    34   Practice for Gynecology and Obstetrics Wihlfahrt, Kiel, Germany

  • T Basali

    35   Department of Gynecology and Obstetrics, Klinikum Stuttgart – Olgahospital, Stuttgart, Germany

  • M Thill

    36   Department of Gynecology and Gynecological Oncology, AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany

  • M P Lux

    37   Department of Gynecology and Obstetrics, Frauenklinik St. Louise, Paderborn, Frauenklinik St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Kliniken, Paderborn, Germany

  • S Loibl

    38   German Breast Group, Neu-Isenburg, Germany
    39   Centre for Haematology and Oncology Bethanien, Frankfurt am Main, Germany

  • H-C Kolberg

    40   Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany

  • J-U Blohmer

    41   Department of Gynecology and Breast Center, Charité-Universitätsmedizin, Berlin, Germany

  • M Hahn

    42   Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany

  • M G Gurleyik

    43   Ministry of Health Istanbul Provincial Health Directorate Istanbul Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey

  • M Porpiglia

    44   Breast Unit S. Anna Hospital, Torino, Italy

  • S Gunay

    45   Breast Surgery Department, Okan University Faculty of Medicine, General Surgery Clinic, Istanbul, Turkey

  • L Holmstrand-Zetterlund

    6   Department of Surgery, Breast Center, Capio St. Göran's Hospital, Stockholm, Sweden
    46   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

  • T Kühn

    47   Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
    48   Breast Cancer Center, Die Filderklinik, Filderstadt, Germany
Further Information
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Objective: Marking metastatic lymph nodes before neoadjuvant chemotherapy (NACT) has become increasingly popular in the surgical treatment of breast cancer. Different devices such as clips or seeds for probe-guided detection are currently in use. While it is not always possible to detect and remove all markers, there is no data on the clinical significance of lost markers or recommendations on proceeding in these cases.

Methods: Out of all participants of the AXSANA study, those planned for target lymph node biopsy (TLNB) or targeted axillary dissection (TAD) and with completed post-NACT locoregional therapy (surgery and radiotherapy) by January 21, 2025, were included.

Results: In 88 of 1,528 patients (5.8%), not all axillary markers could be removed during surgery. The lost marker rate significantly 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 0.013). Additional postoperative imaging was performed in 26 (29.5%) and invasive procedures to remove axillary markers in 9 (10.2%) 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).

Summary: Lost axillary markers may result in additional imaging or invasive procedures. This can be avoided by using markers with a low risk of loss.



Publication History

Article published online:
04 June 2025

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