# Current Indications for Seed-Marked Axillary Lymph Node Dissection in Breast Cancer

## TL;DR

This study identifies when placing markers in lymph nodes is most useful for breast cancer surgery, especially after certain treatments.

## Contribution

The study identifies specific clinical scenarios where seed-marked axillary lymph node dissection is most beneficial.

## Key findings

- The primary use of seed-marked axillary lymph node dissection is after neoadjuvant therapy.
- The extirpation rate of marked nodes was 100%, and sentinel node concordance was 85% in targeted dissections.
- Seed placement allowed avoiding unnecessary lymph node removal in some initial surgery cases.

## Abstract

Marker placement in pathological lymph nodes can improve resection rates in breast cancer with limited axillary involvement. Our goal was to assess in which cases seed-marked axillary lymph node dissection (SMALND) is indicated. Our findings concluded that the most prevalent indication was after neoadjuvant therapy, followed by initial surgery and axillary recurrence. The extirpation rate of the marked axillary node was 100%, and in the case of targeted axillary dissection (TAD), the rate of concordance between the sentinel node and the marked axillary node was 85%. The use of seeds was proven to be highly useful in neoadjuvant therapy and in cases of primary surgery with low axillary involvement or a single axillary recurrence.

Purpose: Marker placement in a pathological node improves extirpation rates in breast cancer cases with limited axillary involvement. Our goal was to assess the current indications for seed-marked axillary lymph node dissection (SMALND). Methods: We conducted a descriptive observational study, including 93 patients with cN1 breast cancer treated between January 2019 and December 2023. Seed placement was performed under ultrasound guidance, days before the procedure. Intraoperative detection was achieved using a probe, and resection was confirmed radiologically. Results: The primary indication was post-neoadjuvant therapy (72 patients: 60 for chemotherapy and 12 for hormone therapy), followed by initial surgery (14) and a single axillary recurrence (8). The extirpation rate of the marked axillary lymph node was 100%. In targeted axillary dissection (TAD), the concordance rate between the sentinel node and the marked axillary node was 85%. In the 12 cases of initial surgery, axillary lymphadenectomy was avoided because the marked node matched the sentinel node and was the only one involved. Conclusions: The use of seeds was proven to be highly useful in axillary surgery, both in cases of negativization following neoadjuvant therapy and in those with low axillary involvement or a single axillary recurrence.