Departments of *Surgical Oncology †Pathology ‡Radiology §Medical Oncology; and ¶Statistics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Ann Surg. 2015 Feb;261(2):378-82. doi: 10.1097/SLA.0000000000000558.
The MARI procedure [marking the axillary lymph node with radioactive iodine (I) seeds] is a new minimal invasive method to assess the pathological response of nodal metastases after neoadjuvant systemic treatment (NST) in patients with breast cancer. This method allows axilla-conserving surgery in patients responding well to NST.
Prior to NST, proven tumor-positive axillary lymph nodes were marked with a I seed. This marked lymph node is the so-called MARI-node. After NST, the MARI node was selectively removed using a γ-detection probe. A complementary axillary lymph node dissection was performed in all patients to assess whether pathological response in the MARI node was indicative for the pathological response in the additional lymph nodes.
A tumor-positive axillary lymph node was marked with a I seed in 100 patients. The MARI node was successfully identified in 97 of these 100 patients (identification rate 97%). Two patients did not undergo subsequent axillary lymph node dissection, leaving 95 patients for further analysis. The MARI node contained residual tumor cells in 65 of these 95 patients. In the other 30 patients, the MARI node was free of tumor, but additional positive lymph nodes were found in 5 patients. Thus, the MARI procedure correctly identified 65 of 70 patients with residual axillary tumor activity (false negative rate 5/70 = 7%).
This study shows that marking and selectively removing metastatic lymph nodes after neoadjuvant systemic treatment has a high identification rate and a low false negative rate. The tumor response in the marked lymph node may be used to tailor further axillary treatment after NST.
MARI 程序（用放射性碘（I）种子标记腋窝淋巴结）是一种新的微创方法，用于评估乳腺癌患者新辅助全身治疗（NST）后淋巴结转移的病理反应。该方法允许对 NST 反应良好的患者进行保腋窝手术。
在 NST 之前，用 I 种子标记已证实的肿瘤阳性腋窝淋巴结。这个标记的淋巴结就是所谓的 MARI 淋巴结。NST 后，使用γ探测探头选择性地切除 MARI 淋巴结。所有患者均行补充腋窝淋巴结清扫术，以评估 MARI 淋巴结的病理反应是否提示其他淋巴结的病理反应。
100 例患者中有肿瘤阳性腋窝淋巴结被标记为 I 种子。在这 100 例患者中的 97 例（识别率 97%）成功识别出 MARI 淋巴结。有 2 例患者未行后续腋窝淋巴结清扫术，95 例患者进行了进一步分析。在这 95 例患者中，有 65 例 MARI 淋巴结中仍有残留肿瘤细胞。在其他 30 例患者中，MARI 淋巴结无肿瘤，但 5 例患者发现了其他阳性淋巴结。因此，MARI 程序正确识别了 70 例残留腋窝肿瘤活动患者中的 65 例（假阴性率为 5/70=7%）。
本研究表明，标记并选择性切除新辅助全身治疗后的转移性淋巴结具有较高的识别率和较低的假阴性率。标记淋巴结的肿瘤反应可用于 NST 后进一步定制腋窝治疗。
