ArticleBreast cancer research and treatment2022
Three-year follow-up of de-escalated axillary treatment after neoadjuvant systemic therapy in clinically node-positive breast cancer: the MARI-protocol.
Article in Breast cancer research and treatment, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
39 citing papers in PubMed, 3 syntheses or guidelines pooled it, 70 citations in OpenAlex.
- Different strategies in de-escalation of axillary surgery in node-positive breast cancer following neoadjuvant treatment: a systematic review and meta-analysis of long-term outcomes.Breast cancer (Tokyo, Japan) · 2025Pooled it
- Systematic review of targeted axillary dissection in node-positive breast cancer treated with neoadjuvant systemic therapy: variation in type of marker and timing of placement.The British journal of surgery · 2024Pooled it
- Uncertainties and controversies in axillary management of patients with breast cancer.Cancer treatment reviews · 2023Pooled it
- Disease extent according to baseline [18F]fluorodeoxyglucose PET/CT and molecular subtype: prediction of axillary treatment response after neoadjuvant systemic therapy for breast cancer.The British journal of surgery · 2024Trial
- Impact of Imaging-Guided Localization on Performance of Tailored Axillary Surgery in Patients with Clinically Node-Positive Breast Cancer: Prospective Cohort Study Within TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101).Annals of surgical oncology · 2024Trial
- Management of the Axilla After Neoadjuvant Chemotherapy: Can Axillary Needle Biopsy Replace Sentinel Node Biopsy?In vivo (Athens, Greece)Trial
- Axillary management in patients with cN + breast cancer undergoing neoadjuvant chemotherapy: pattern of practice in Italy.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Article
- Nuclear medicine in the operating room: present and future.The British journal of radiology · 2026Review
- Pathological complete response and postmastectomy radiation therapy after primary systemic therapy: results from the ReSTORE study.Breast (Edinburgh, Scotland) · 2026Observational
- Radioguided Surgery and Axillary Management in Breast Cancer: From Molecular Imaging to 3D Navigation Toward Personalized Treatment.Life (Basel, Switzerland) · 2026Review
- Primary tumour response on breast MRI as a predictor of axillary pathologic response in breast cancer patients treated with neoadjuvant chemotherapy.European radiology · 2026Article
- Neoadjuvant endocrine therapy often leads to breast and axilla-conserving surgery in stages II and III hormone receptor-positive breast cancer patients: A registry study.International journal of cancer · 2026Article
- Impact of axillary disease extent defined by baselineBreast (Edinburgh, Scotland) · 2026Article
- Oncologic First Events in Breast Cancer Patients After Targeted Axillary Dissection.Annals of surgical oncology · 2025Article
- Multi-omics prediction of axillary treatment response and tumour microenvironment alterations in lymph node-positive luminal breast cancer.Cell death & disease · 2025Article
- An Overview of the Importance of Neoadjuvant Systemic Therapy for Breast Cancer Patients: From the Society of Surgical Oncology and the American Society of Breast Surgeons.Annals of surgical oncology · 2025Review
- Axillary lymph node management strategies in cN + breast cancer patients after neoadjuvant chemotherapy.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2025Review
- Article
- De-Escalation of Nodal Surgery in Clinically Node-Positive Breast Cancer.JAMA surgery · 2025Observational
- Breast Cancer Recurrence in Initially Clinically Node-Positive Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in the NEOSENTITURK-Trials MF18-02/18-03.Annals of surgical oncology · 2025Article
Corrections and comments
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Authors and funding
11 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIn clinically node-positive (cN+) breast cancer patients, evidence supporting response-guided treatment after neoadjuvant systemic therapy (NST) instead of axillary lymph node dissection (ALND) is increasing, but follow-up results are lacking. We assessed three-year axillary recurrence-free interval (aRFI) in cN+ patients with response-adjusted axillary treatment according to the 'Marking Axillary lymph nodes with Radioactive Iodine seeds' (MARI)-protocol.
methodsWe retrospectively assessed all stage II-III cytologically proven cN+ breast cancer patients who underwent the MARI-protocol between July 2014 and November 2018. Pre-NST axillary staging with FDG-PET/CT (less- or more than four suspicious axillary nodes; cALN < 4 or cALN ≥ 4) and post-NST pathological axillary response measured in the pre-NST largest tumor-positive axillary lymph node marked with an iodine seed (MARI-node; ypMARI-neg or ypMARI-pos) determined axillary treatment: no further treatment (cALN < 4, ypMARI-neg), axillary radiotherapy (ART) (cALN < 4, ypMARI-pos and cALN ≥ 4, ypMARI-neg) or ALND plus ART (cALN ≥ 4, ypMARI-pos).
resultsOf 272 women included, the MARI-node was tumor-negative in 56 (32%) of 174 cALN < 4 patients and 43 (44%) of 98 cALN ≥ 4 patients. According to protocol, 56 (21%) patients received no further axillary treatment, 161 (59%) received ART and 55 (20%) received ALND plus ART. Median follow-up was 3.0 years (IQR 1.9-4.1). Five patients (one no further treatment, four ART) had axillary metastases. Three-year aRFI was 98% (95% CI 96-100). The overall recurrence risk remained highest for patients with ALND (HR 4.36; 95% CI 0.95-20.04, p = 0.059).
conclusionsDe-escalation of axillary treatment according to the MARI-protocol prevented ALND in 80% of cN+ patients with an excellent three-year aRFI of 98%.
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