Comparative evaluation of contemporary axillary lymph node marking techniques prior to neoadjuvant systemic therapy in metastatic axillary lymph node involvement

This review provides a comparative evaluation of current techniques for marking axillary lymph nodes in breast cancer patients with initially positive axillary status (cN+) undergoing neoadjuvant systemic therapy. The main methods of localizing marked nodes are analyzed, including carbon suspension, wire localization, titanium clips, magnetic seeds (Magseed), radioactive seeds (I-125 RSL, MARI procedure), and radar localization (SAVI SCOUT), with a focus on identification rate, false-negative rate, safety, and cost-effectiveness. The implementation of targeted axillary dissection with selective removal of the pre-marked metastatic node has been shown to reduce the false-negative rate to 1.4–4.1 %. However, no single “gold standard” for marking currently exists, and the choice of technique depends on individual clinical, logistical, and economic factors. Further prospective studies are required to evaluate long-term oncological outcomes.