# Reducción del 82% de Linfadenectomías Axilares Combinando PET/CT pre-NAC + MARI post-NAC

**Autores:** van der Noordaa MEM, van Duijnhoven FH, Straver ME, Groen EJ, Stokkel M, Loo CE, Elkhuizen PHM, Russell NS, Vrancken Peeters MTFD (Netherlands Cancer Institute)
**Revista:** Annals of Surgical Oncology (2018)
**PMID:** 29511992 | **PMCID:** —
**DOI:** [10.1245/s10434-018-6404-y](https://doi.org/10.1245/s10434-018-6404-y)
**Fuente:** PubMed (abstract only — full text vía DOI/institución)

## Relevancia
Implementación clínica del MARI con estratificación pre-NAC por PET/CT: protocolo holandés que **reduce las ALND al 18%** de pacientes cN+. Define decisiones según número de ganglios FDG-ávidos pre-NAC + estado del MARI node post-NAC.

## Algoritmo holandés (de este protocolo)

| Pre-NAC PET/CT | MARI node post-NAC | Tratamiento axilar |
|---|---|---|
| cN1-3 (1-3 FDG-ávidos) | MARI negativo | **Ninguno** |
| cN1-3 | MARI positivo | Radioterapia locorregional |
| cN4+ (≥4 FDG-ávidos) | MARI negativo | Radioterapia locorregional |
| cN4+ | MARI positivo | ALND |

## Abstract

Axillary lymph node dissection (ALND) is frequently performed for node-positive (cN+) breast cancer patients. Combining positron emission tomography/computed tomography (PET/CT) before-NST and the MARI procedure after NST has the potential for avoiding unnecessary ALNDs.

All breast cancer patients treated with NST at the Netherlands Cancer Institute who underwent PET/CT and MARI from July 2014 to July 2017 were included. All patients underwent tailored axillary treatment according to a protocol based on combined PET/CT pre-NST and MARI post-NST results.

**Results:** 159 patients analyzed. 110 had 1-3 FDG-avid ALNs, 49 had ≥4. **For 130 patients (82%), ALND was omitted.** Locoregional radiotherapy: 91 patients (57%); no further axillary treatment: 39 patients (25%).

**Conclusion:** Combining pre-NST PET/CT with post-NST MARI resulted in **82% reduction of ALNDs** for cN+ breast cancer patients.

## Acceso
Artículo no disponible en PMC. Acceder vía [DOI](https://doi.org/10.1245/s10434-018-6404-y) o suscripción institucional.

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*Datos de PubMed. Citar: doi 10.1245/s10434-018-6404-y*
