Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)

the AXSANA Study Group; Steffi Hartmann; Maggie Banys-Paluchowski; Tomasz Berger; Nina Ditsch; Elmar Stickeler; Jana de Boniface; Oreste Davide Gentilini; Jennifer Schroth; Guldeniz Karadeniz Cakmak; Isabel T. Rubio; Maria Luisa Gasparri; Michalis Kontos; Eduard Alexandru Bonci; Laura Niinikoski; Dawid Murawa; Geeta Kadayaprath; David Pinto; Florentia Peintinger; Ellen Schlichting; Lukas Dostalek; Helidon Nina; Hagigat Valiyeva; Marian Vanhoeij; Andraž Perhavec; Douglas Zippel; Lia Pamela Rebaza; Sarun Thongvitokomarn; Sarah Fröhlich; Franziska Ruf; Angelika Rief; Kristina Wihlfahrt; Timo Basali; Marc Thill; Michael Patrick Lux; Sibylle Loibl; Hans Christian Kolberg; Jens Uwe Blohmer; Markus Hahn; Meryem Gunay Gurleyik; Mauro Porpiglia; Semra Gunay; Linda Zetterlund; Thorsten Kuehn; Agnieszka Kolacinska-Wow; Alberto Silva; Alessandro Fancellu; Alexander Hein; Dorothea Fischer; Frederik Felipe Fromm; Telja Pursche

doi:10.1016/j.ejso.2025.110253

Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)

the AXSANA Study Group, Steffi Hartmann^*, Maggie Banys-Paluchowski, Tomasz Berger, Nina Ditsch, Elmar Stickeler, Jana de Boniface, Oreste Davide Gentilini, Jennifer Schroth, Guldeniz Karadeniz Cakmak, Isabel T. Rubio, Maria Luisa Gasparri, Michalis Kontos, Eduard Alexandru Bonci, Laura Niinikoski, Dawid Murawa, Geeta Kadayaprath, David Pinto, Florentia Peintinger, Ellen SchlichtingLukas Dostalek, Helidon Nina, Hagigat Valiyeva, Marian Vanhoeij, Andraž Perhavec, Douglas Zippel, Lia Pamela Rebaza, Sarun Thongvitokomarn, Sarah Fröhlich, Franziska Ruf, Angelika Rief, Kristina Wihlfahrt, Timo Basali, Marc Thill, Michael Patrick Lux, Sibylle Loibl, Hans Christian Kolberg, Jens Uwe Blohmer, Markus Hahn, Meryem Gunay Gurleyik, Mauro Porpiglia, Semra Gunay, Linda Zetterlund, Thorsten Kuehn, Agnieszka Kolacinska-Wow, Alberto Silva, Alessandro Fancellu, Alexander Hein, Dorothea Fischer, Frederik Felipe Fromm, Telja Pursche

^*Corresponding author for this work

2 Citations (Scopus)

Abstract

Introduction: Marking metastatic lymph nodes before neoadjuvant chemotherapy (NACT) has become increasingly popular in the surgical treatment of breast cancer. A variety of devices are currently in use. However, the significance of lost markers is poorly understood, and their impact on clinical decisions is unclear. Materials and methods: Among participants enrolled in the prospective AXSANA cohort study, those planned for target lymph node biopsy (TLNB) or targeted axillary dissection (TAD) with completed post-NACT locoregional therapy (surgery and radiotherapy) by January 21, 2025, were included. Results: In 88 of 1528 patients (5.8 %), axillary markers could not successfully be removed during surgery after NACT. The lost marker rate 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 < 0.001). Additional postoperative imaging was performed in 25 (28.4 %) and further surgery to remove axillary markers was performed in 6 (6.8 %) 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). Conclusion: The loss of markers in TLNB/TAD is uncommon and significantly depends on the marking technique. Lost markers may lead to diagnostic uncertainties and additional imaging or surgical procedures.

Original language	English
Article number	110253
Journal	European Journal of Surgical Oncology
Volume	51
Issue number	9
ISSN	0748-7983
DOIs	https://doi.org/10.1016/j.ejso.2025.110253
Publication status	Published - 01.2025

Research Areas and Centers

Research Area: Luebeck Integrated Oncology Network (LION)

DFG Research Classification Scheme

2.22-14 Hematology, Oncology
2.22-21 Gynaecology and Obstetrics

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ejso.2025.110253

Cite this

the AXSANA Study Group, Hartmann, S., Banys-Paluchowski, M., Berger, T., Ditsch, N., Stickeler, E., de Boniface, J., Gentilini, O. D., Schroth, J., Karadeniz Cakmak, G., Rubio, I. T., Gasparri, M. L., Kontos, M., Bonci, E. A., Niinikoski, L., Murawa, D., Kadayaprath, G., Pinto, D., Peintinger, F., ... Pursche, T. (2025). Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655). European Journal of Surgical Oncology, 51(9), Article 110253. https://doi.org/10.1016/j.ejso.2025.110253

@article{d52409055b5c43b8a0b55c8f669ffbc2,

title = "Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)",

abstract = "Introduction: Marking metastatic lymph nodes before neoadjuvant chemotherapy (NACT) has become increasingly popular in the surgical treatment of breast cancer. A variety of devices are currently in use. However, the significance of lost markers is poorly understood, and their impact on clinical decisions is unclear. Materials and methods: Among participants enrolled in the prospective AXSANA cohort study, those planned for target lymph node biopsy (TLNB) or targeted axillary dissection (TAD) with completed post-NACT locoregional therapy (surgery and radiotherapy) by January 21, 2025, were included. Results: In 88 of 1528 patients (5.8 \%), axillary markers could not successfully be removed during surgery after NACT. The lost marker rate 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 < 0.001). Additional postoperative imaging was performed in 25 (28.4 \%) and further surgery to remove axillary markers was performed in 6 (6.8 \%) 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). Conclusion: The loss of markers in TLNB/TAD is uncommon and significantly depends on the marking technique. Lost markers may lead to diagnostic uncertainties and additional imaging or surgical procedures.",

author = "\{the AXSANA Study Group\} and Steffi Hartmann and Maggie Banys-Paluchowski and Tomasz Berger and Nina Ditsch and Elmar Stickeler and \{de Boniface\}, Jana and Gentilini, \{Oreste Davide\} and Jennifer Schroth and \{Karadeniz Cakmak\}, Guldeniz and Rubio, \{Isabel T.\} and Gasparri, \{Maria Luisa\} and Michalis Kontos and Bonci, \{Eduard Alexandru\} and Laura Niinikoski and Dawid Murawa and Geeta Kadayaprath and David Pinto and Florentia Peintinger and Ellen Schlichting and Lukas Dostalek and Helidon Nina and Hagigat Valiyeva and Marian Vanhoeij and Andra{\v z} Perhavec and Douglas Zippel and Rebaza, \{Lia Pamela\} and Sarun Thongvitokomarn and Sarah Fr{\"o}hlich and Franziska Ruf and Angelika Rief and Kristina Wihlfahrt and Timo Basali and Marc Thill and Lux, \{Michael Patrick\} and Sibylle Loibl and Kolberg, \{Hans Christian\} and Blohmer, \{Jens Uwe\} and Markus Hahn and Gurleyik, \{Meryem Gunay\} and Mauro Porpiglia and Semra Gunay and Linda Zetterlund and Thorsten Kuehn and Agnieszka Kolacinska-Wow and Alberto Silva and Alessandro Fancellu and Alexander Hein and Dorothea Fischer and Fromm, \{Frederik Felipe\} and Telja Pursche",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = jan,

doi = "10.1016/j.ejso.2025.110253",

language = "English",

volume = "51",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "9",

}

the AXSANA Study Group, Hartmann, S, Banys-Paluchowski, M, Berger, T, Ditsch, N, Stickeler, E, de Boniface, J, Gentilini, OD, Schroth, J, Karadeniz Cakmak, G, Rubio, IT, Gasparri, ML, Kontos, M, Bonci, EA, Niinikoski, L, Murawa, D, Kadayaprath, G, Pinto, D, Peintinger, F, Schlichting, E, Dostalek, L, Nina, H, Valiyeva, H, Vanhoeij, M, Perhavec, A, Zippel, D, Rebaza, LP, Thongvitokomarn, S, Fröhlich, S, Ruf, F, Rief, A, Wihlfahrt, K, Basali, T, Thill, M, Lux, MP, Loibl, S, Kolberg, HC, Blohmer, JU, Hahn, M, Gurleyik, MG, Porpiglia, M, Gunay, S, Zetterlund, L, Kuehn, T, Kolacinska-Wow, A, Silva, A, Fancellu, A, Hein, A, Fischer, D, Fromm, FF & Pursche, T 2025, 'Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)', European Journal of Surgical Oncology, vol. 51, no. 9, 110253. https://doi.org/10.1016/j.ejso.2025.110253

Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655). / the AXSANA Study Group; Hartmann, Steffi; Banys-Paluchowski, Maggie et al.
In: European Journal of Surgical Oncology, Vol. 51, No. 9, 110253, 01.2025.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)

AU - the AXSANA Study Group

AU - Hartmann, Steffi

AU - Banys-Paluchowski, Maggie

AU - Berger, Tomasz

AU - Ditsch, Nina

AU - Stickeler, Elmar

AU - de Boniface, Jana

AU - Gentilini, Oreste Davide

AU - Schroth, Jennifer

AU - Karadeniz Cakmak, Guldeniz

AU - Rubio, Isabel T.

AU - Gasparri, Maria Luisa

AU - Kontos, Michalis

AU - Bonci, Eduard Alexandru

AU - Niinikoski, Laura

AU - Murawa, Dawid

AU - Kadayaprath, Geeta

AU - Pinto, David

AU - Peintinger, Florentia

AU - Schlichting, Ellen

AU - Dostalek, Lukas

AU - Nina, Helidon

AU - Valiyeva, Hagigat

AU - Vanhoeij, Marian

AU - Perhavec, Andraž

AU - Zippel, Douglas

AU - Rebaza, Lia Pamela

AU - Thongvitokomarn, Sarun

AU - Fröhlich, Sarah

AU - Ruf, Franziska

AU - Rief, Angelika

AU - Wihlfahrt, Kristina

AU - Basali, Timo

AU - Thill, Marc

AU - Lux, Michael Patrick

AU - Loibl, Sibylle

AU - Kolberg, Hans Christian

AU - Blohmer, Jens Uwe

AU - Hahn, Markus

AU - Gurleyik, Meryem Gunay

AU - Porpiglia, Mauro

AU - Gunay, Semra

AU - Zetterlund, Linda

AU - Kuehn, Thorsten

AU - Kolacinska-Wow, Agnieszka

AU - Silva, Alberto

AU - Fancellu, Alessandro

AU - Hein, Alexander

AU - Fischer, Dorothea

AU - Fromm, Frederik Felipe

AU - Pursche, Telja

PY - 2025/1

Y1 - 2025/1

N2 - Introduction: Marking metastatic lymph nodes before neoadjuvant chemotherapy (NACT) has become increasingly popular in the surgical treatment of breast cancer. A variety of devices are currently in use. However, the significance of lost markers is poorly understood, and their impact on clinical decisions is unclear. Materials and methods: Among participants enrolled in the prospective AXSANA cohort study, those planned for target lymph node biopsy (TLNB) or targeted axillary dissection (TAD) with completed post-NACT locoregional therapy (surgery and radiotherapy) by January 21, 2025, were included. Results: In 88 of 1528 patients (5.8 %), axillary markers could not successfully be removed during surgery after NACT. The lost marker rate 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 < 0.001). Additional postoperative imaging was performed in 25 (28.4 %) and further surgery to remove axillary markers was performed in 6 (6.8 %) 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). Conclusion: The loss of markers in TLNB/TAD is uncommon and significantly depends on the marking technique. Lost markers may lead to diagnostic uncertainties and additional imaging or surgical procedures.

AB - Introduction: Marking metastatic lymph nodes before neoadjuvant chemotherapy (NACT) has become increasingly popular in the surgical treatment of breast cancer. A variety of devices are currently in use. However, the significance of lost markers is poorly understood, and their impact on clinical decisions is unclear. Materials and methods: Among participants enrolled in the prospective AXSANA cohort study, those planned for target lymph node biopsy (TLNB) or targeted axillary dissection (TAD) with completed post-NACT locoregional therapy (surgery and radiotherapy) by January 21, 2025, were included. Results: In 88 of 1528 patients (5.8 %), axillary markers could not successfully be removed during surgery after NACT. The lost marker rate 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 < 0.001). Additional postoperative imaging was performed in 25 (28.4 %) and further surgery to remove axillary markers was performed in 6 (6.8 %) 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). Conclusion: The loss of markers in TLNB/TAD is uncommon and significantly depends on the marking technique. Lost markers may lead to diagnostic uncertainties and additional imaging or surgical procedures.

UR - https://www.scopus.com/pages/publications/105009151642

UR - https://www.mendeley.com/catalogue/0b8cf2b3-9205-3801-9512-b4b40176f42a/

U2 - 10.1016/j.ejso.2025.110253

DO - 10.1016/j.ejso.2025.110253

M3 - Journal articles

AN - SCOPUS:105009151642

SN - 0748-7983

VL - 51

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 9

M1 - 110253

ER -

Lost axillary markers after neoadjuvant chemotherapy in breast cancer patients - data from the prospective international AXSANA (EUBREAST 3) cohort study (NCT04373655)

Abstract

Research Areas and Centers

DFG Research Classification Scheme

UN SDGs

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