Marking of Target Lymph Nodes with carbon suspension in breast cancer patients undergoing neoadjuvant chemotherapy – first results from the AXSANA study (NCT04373655)

Background: Targeted axillary dissection (TAD) is a widely used axillary staging technique in patients with breast cancer converting from cN+to ycN0 after neoadjuvant chemotherapy (NACT). TAD includes removing the sentinel lymph node and the metastatic lymph node marked before NACT, referred to as the target lymph node (TLN). Various techniques for TLN marking are in use, including clips/coils, magnetic seeds, radar markers, radioactive seeds, RFID tags, and carbon suspension. In contrast to other marking methods, no additional pre- or intraoperative localization is required after carbon marking, as the TLN is detected purely visually. Materials and Methods: The international, multicenter non-interventional AXSANA study prospectively evaluates performance and clinical outcome of different surgical axillary staging techniques in initially node-positive patients who convert to clinical node negativity. A secondary aim of the study is to determine the detection rate (DR) of the various TLN markers used. Results: At least one TLN was marked in 2823 out of 5154 (54.8%) patients before NACT. Carbon suspension was used in 204 out of 2823 (7.2%) patients. In 125 (61.3%) of these patients, a TLN biopsy (TLNB) or TAD was planned, and final results from surgery are available. The DR for the carbon marked TLN was 97.6% (122 out of 125). A median of 1 TLN was removed (range 0-7).