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

Le résumé fourni par la source

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).

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