ArticleJAMA oncology2025
Iodine Seed-Marking Protocol for Response-Guided Axillary Treatment After Systemic Therapy for Node-Positive Breast Cancer.
Article in JAMA oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Carbon (charcoal) tattoo localization of biopsy-proven metastatic axillary lymph nodes for targeted axillary dissection after neoadjuvant therapy in breast cancer: a systematic review and single -arm meta-analysis.World journal of surgical oncology · 2026Pooled it
- Prognostic impact of radiotherapy dose to the axilla in cN + /ypN0 breast cancer after primary systemic therapy and sentinel lymph node biopsy: toward true de-escalation of axillary management.Breast cancer (Tokyo, Japan) · 2026Article
- Nuclear medicine in the operating room: present and future.The British journal of radiology · 2026Review
- Stained region lymph node biopsy for axillary restaging after neoadjuvant systemic therapy in node-positive breast cancer: a cohort study.Journal of cancer research and clinical oncology · 2026Article
- Iodine seed-marking protocol for response-guided axillary de-escalation after neoadjuvant therapy in node-positive breast cancer.Translational cancer research · 2026Article
- MRI-Based Deep Learning Guides Multi-Omics Discovery of NBPF4 as a Therapeutic Target for Breast Cancer Lymph Node Metastasis.Research (Washington, D.C.) · 2026Article
- Impact of pre-neoadjuvant radioactive iodine seed marking on pathologic complete response and survival in early-stage breast cancer patients.Cancer biology & medicine · 2025Article
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11 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Importance: Most patients with clinically node-positive (cN+) breast cancer receive primary systemic treatment (PST) followed by axillary lymph node dissection (ALND) and/or locoregional radiation (RT). The necessity of axillary treatment in patients achieving nodal pathologic complete response (pCR) after PST remains uncertain. Objective: To assess oncologic outcomes of response-guided axillary treatment determined by marking the axillary lymph node with a radioactive iodine seed (MARI) in patients with cN+ breast cancer who experience pCR after PST. Design, Setting, and Participants: This cohort study was conducted at a single center including patients with breast cancer with 3 or fewer axillary lymph nodes on fluorodeoxyglucose positron emission tomography-computed tomography who were treated according to the MARI protocol from July 2014 to December 2021. Patients with intramammary or periclavicular lymph node involvement were excluded. Median (IQR) follow-up was 49 (32-70) months. Data were analyzed from March to June 2025. Exposure: After PST, the MARI-marked lymph node was excised. Patients with pCR of the MARI node (ypN0) received no further axillary treatment, whereas patients with residual disease (ypN+) received locoregional radiation therapy. Main Outcomes and Measures: The primary outcome measure was axillary recurrence rate. The secondary outcome measures were 5-year invasive disease-free survival (iDFS) and overall survival (OS). Results: In total, 350 patients (median [IQR] age, 49 [41-56] years) were included and analyzed; of these, 135 (39%) had ypN0 and received no further axillary treatment. The remaining 215 patients with ypN+ (61%) received RT. After a median (IQR) follow-up of 49 (32-70) months, axillary recurrence rate was 0.7% (n = 1; 95% CI, 0.04%-4.1%) in patients with ypN0 and 2.3% (n = 7; 95% CI, 1.0%-5.3%) in patients with ypN+. In patients with ypN0, the 5-year iDFS was 93% (95% CI, 88%-98%) and the OS was 98% (95% CI, 95%-100%); in patients with ypN+, iDFS was 87% (95% CI, 82%-93%) and OS, 93% (95% CI, 89%-97%). Conclusions and Relevance: This cohort study found that response-guided axillary treatment, using the MARI protocol, in patients with limited nodal disease who received PST was associated with a very low risk of axillary recurrence and should be considered to protect patients from axillary overtreatment.
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