| Autor: |
Alamoodi M; London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.; Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia., Wazir U; London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK., Sakr RA; College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates.; Department of Oncoplastic Surgery, King's College Hospital London, Dubai P.O. Box 340901, United Arab Emirates., Venkataraman J; London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK., Mokbel K; London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.; Health and Care Profession Department, College of Medicine and Health, University of Exeter Medical School, Exeter B3183, UK., Mokbel K; London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK. |
| Abstrakt: |
Background/Objectives: De-escalation of axillary surgery is made possible by advancements in both neoadjuvant systemic therapy (NST) and in localisation technology for breast lesions. Magseed ® , developed in 2013 by Dr. Michael Douk of Cambridge, United Kingdom, is a wire-free localisation technology that facilitates the localisation and retrieval of lymph nodes for staging. Targeted axillary dissection (TAD), which entails marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB), has emerged as the preferred method to assess residual disease in post-NST node-positive patients. This systematic review and pooled analysis evaluate the performance of Magseed ® in TAD. Methods: The search was carried out in PubMed and Google Scholar. An assessment of localisation, retrieval rates, concordance between MLNB and SLNB, and pathological complete response (pCR) in clinically node-positive patients post NST was undertaken. Results : Nine studies spanning 494 patients and 497 procedures were identified, with a 100% successful deployment rate, a 94.2% (468/497) [95% confidence interval (CI), 93.7-94.7] localisation rate, a 98.8% (491/497) retrieval rate, and a 68.8% (247/359) [95% CI 65.6-72.0] concordance rate. pCR was observed in 47.9% (220/459) ) [95% CI 43.3-52.6] of cases. Subgroup analysis of studies reporting the pathological status of MLNB and SLNB separately revealed an FNR of 4.2% for MLNB and 17.6% for SLNB ( p = 0.0013). Mean duration of implantation was 37 days (range: 0-188). Conclusions: These findings highlight magnetic seed localisation's efficacy in TAD for NST-treated node-positive patients, aiding in accurate axillary pCR identification and safe de-escalation of axillary surgery in excellent responders. |
