Abstract
Background
De-escalation of axillary surgery for lymph node (LN) positive breast cancer is facilitated
by marking involved nodes which, when removed with sentinel nodes constitute risk-adapted
targeted axillary dissection (TAD). Whether after chemotherapy or for primary surgery,
selected patients with biopsy-proven involvement of nodes may be eligible for axillary
conservation. Likewise, impalpable recurrence or stage 4 patients with localised axillary
disease may benefit.
In these contexts, several devices are used to mark biopsied nodes to facilitate their
accurate surgical removal. We report our experience using the paramagnetic MAGSEED
(Endomag®, Cambridge, UK).
Methods
Local approval (BR2021_149) was obtained to interrogate a prospective database of
all axillary markers. The primary endpoint was successful removal of the marked LN.
Results
Of 241 markers (in 221 patients) inserted between October 2018 and July 2022, all
were retrieved.
Of 74 patients who had Magseeds® inserted after completion of NACT (involved nodes
initially marked using an UltraCor™Twirl™ marker), the Magseeds® were found outside
the node in neighbouring axillary tissue in 18 (24.3%) patients. When Magseeds® were
placed at commencement of NACT in 54 patients, in only 1 (1.8%) was the marker found
outside the node – a statistically significantly lower rate (Chi2 10.7581 p = 0.001038). For ‘primary TAD’ patients and those localised for recurrent
or stage IV disease, all 93 had the Magseed® found within the biopsied node.
Conclusion
This series supports our axillary nodal marking technique as safe and reliable. For
TAD following NACT, placement at the start of treatment led to a significantly higher
localisation rate.
keywords
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Article info
Publication history
Published online: January 31, 2023
Accepted:
December 30,
2022
Received in revised form:
December 18,
2022
Received:
September 18,
2022
Identification
Copyright
Crown Copyright © 2023 Published by Elsevier Ltd. All rights reserved.
